Retrospective #470: A Tale of Two Paradigms

Sitting next to a good friend – waiting for a memorial service to begin – I asked her if she was pre-diabetic. Huffily she replied that she was not! Her fasting blood sugars were all in the “low hundreds,” she said, which her doctor told her was okay. She’s happy because she thinks she’s avoided the dreaded T2 diagnosis and the drugs. But she’s “a little” overweight, like most of us, so I supposed she might also be a little Insulin Resistant. And, of course, she was pre-diabetic.

Tragically, this is how the Medical Treatment Paradigm for Type 2 Diabetes works, historically and for the most part as it exists today.  The doctor might have told a patient with a blood sugar in the “low hundreds” to “lose weight and move more.” But my friend is in her mid-eighties, still working hard, and no doubt very glad to be alive and declared “well.” A good doctor might also have counseled my friend to take Metformin and eat fewer carbs, but given her age and the new, very lax ADA Standards of Medical Practice for older people, she probably didn’t.

Doctors are taught to diagnose disease and treat symptoms by prescribing medicine. But almost all of us are “a little” overweight, and everyone is getting older, so what’s a doctor to do? Prescribe Metformin for every one? Ironically, that’s not a rhetorical question. There’s evidence that Metformin extends longevity even in a non-insulin resistant population. It's been suggested in this peer-reviewed article that maybe everyone should take Metformin. It’s cheap and, except for brief intestinal distress in about 20% of those who start on it, it has no other side effects.

But even in the best of circumstances, in our 40s when we start to develop Insulin Resistance and put on a few pounds, a doctor today would still just counsel “diet and exercise,” and when that fails – as it invariably does – initiate drug therapy. And Metformin is the first line of pharmacotherapy recommended almost universally. In the clinical world the debate these days is what should be the 2^nd and 3^rd course of oral medications, before the doctor begins a more advanced drug like an injectable GLP-1 incretin mimetic, or an SGLT-2, and finally, insulin therapy.

This is how the Medical Paradigm dominates the treatment of Type 2 Diabetes. We all wait too long to start taking it seriously, and consider treating Type 2 Diabetes) as something doctors do. Ironically, it is totally lost on us (and the doctors) that the reason we gained weight was a due to a medical condition called Insulin Resistance, whose best MEDICAL treatment is a Lifestyle Change: a change in our DIET. Weight gain and Type 2 Diabetes both arose because for years we ate way too many refined carbohydrates and simple sugars. That’s why we got fat and sick.

The Dietary Treatment Paradigm for Type 2 Diabetes is rarely suggested in the doctor’s office. There are many reasons for this, but suffice it to say it is both “safe and effective.” And so long as YOU follow this dietary “treatment” (eating Very Low Carb), you will lose weight (a lot of it, if you want) and your blood sugars (e.g, your A1c) will get much better. Many people report A1c’s below the pre-diabetic threshold (5.7%). My first A1c, taken by an endocrinologist more than 25 years ago, was 8.9%. Last December it was 5.0%, rock solid normal…and clinically, non-diabetic.

So, the question arises: What will it take to bring about a revolution in the basic principles and practices of medicine to make this Paradigm Shift, a shift from the Medical to the Dietary Treatment for Type 2 Diabetes? It does not require a shift in all the “principles and practices of medicine.” It is only because TYPE 2 DIABETES IS A DIETARY DISEASE that a change of diet is needed. Until doctors make this shift, patients must learn that TYPE 2 DIABETES IS “REVERSIBLE” THROUGH DIET and then take responsibility for their own health at every meal. Treating an elevated blood sugar with drugs, because “that is something doctors do,” is “old school.” Until that day comes, the protocol for diagnosing Type 2 Diabetes and treating it with drugs will continue to be the Medical model.

Doctors likewise need to be reminded that Hippocrates, the Father of Medicine, said, “Let food be thy medicine and medicine be thy food.” If you have fasting blood sugars in the “low hundreds,” you have Insulin Resistance. You’re “Pre-diabetic.”  And if you want to avoid the clinical diagnosis, and the complications, now is the time to change what you eat. Don’t wait before you graduate to finger sticks and a cocktail of drugs…and worse.  

Retrospective #469: Why Pre-diabetes is actually Type 2 Diabetes

I’m not trying to be alarmist here. It’s just that there’s a broad misunderstanding in the patient population about what type 2 diabetes is. It is perhaps due to a misunderstanding or a reluctance by most clinicians to counsel patients that a diagnosis (Dx) of Pre-diabetes is prima facie evidence of an already failed glucose metabolism. The biomarkers used, an A1c of ≥5.7% (39mmol/mol) and/or an elevated blood sugar (≥100mg/dl or 5.6mmol/L or 6.1 in the UK) is proof.

Most clinicians understand that a Dx of T2DM means that you have Insulin Resistance (IR). IR means that the uptake of glucose by the body is impaired by the failure of the hormone insulin, which accompanies glucose in the blood, to induce receptor cells to open. This results in the level of circulating glucose to stay elevated . The body fights this by sending more insulin. And as long as it sends more insulin, you remain “Pre-diabetic” (and you gain weight).

Here’s the misunderstanding. Your body has been successfully fighting IR by sending more insulin. And because it has been “successful” – keeping your blood glucose levels in the high-normal or even “Pre-diabetic” range – you, and ruefully in most cases your clinician, think you are not already a type 2 diabetic. The truth, however, is that you are because you have IR (the definition of T2DM) and YOUR BODY, by fighting it off, is CONCEALING it from you.

Your pancreas will fight to make enough insulin to keep your blood sugar “normal,” until it no longer can. That failure is what constitutes a clinical diagnosis today, but this late symptom of a dysfunctional glucose metabolism is after the fact. You have had type 2 diabetes all along, and your pancreas has exhausted its ability to make enough insulin. Either the cells that make insulin have died or are so clogged with fat that they are blocked from functioning properly.

So, what should your clinician tell you, or you do, instead? If you have been told that you have a “slightly elevated” or “high-normal” or even a “Pre-Diabetic” blood glucose, accept that 1) you have Insulin Resistance, and 2) that having Insulin Resistance is the definition of T2DM. Now is the time to do something about it. Most clinicians will counsel you to “wait and see.” That’s because under clinical guidelines (and Medicare and other insurance rules), they can’t write you an Rx until you have been “clinically diagnosed.” But by then it’s too late. Your pancreas has already failed.

But up until this point your doctor is in something of a bind. He can tell you to “diet and exercise,” but government’s idea of a “healthy diet” is to eat a “mostly plant-based” or even a “balanced” Mediterranean diet. You’ve also been led to think that exercise is an effective weight loss strategy. It’s not. Your doctor is also unlikely to know or believe that the diet or “lifestyle change” that will work to reverse your dysfunctional glucose metabolism is a LOW CARB diet.

Nevertheless, losing weight is a good prescription, especially losing weight around the waist. Central obesity and belly fat are terms for visceral fat. As distinguished from subcutaneous fat, this is fat within the abdomen, around and within the organs, especially the liver and pancreas. This is why some people who are not obese have T2D. They are “skinny-fat” with a fat-clogged pancreas and probably a fatty liver (NAFLD) as well. Losing this visceral fat can help restore function to pancreas for the obese, overweight and “skinny-fat” or viscerally obese.

Restoring pancreatic function only addresses the failed insulin production aspect of T2DM. Remember, this is the late symptom of a failed glucose metabolism, not the cause of T2DM, which is Insulin Resistance. What can be done to reverse IR? Well, ask yourself, what caused the resistance to insulin? Answer: Too much insulin! And what caused too much insulin? A diet too high in carbohydrates: eating too many carbs all day long, in every meal and in between. Solution: Change what you eat. Cut the refined carbs and simple sugars. Keep an eye on your fasting insulin level.

You got into this mess by eating far, far too many carbs. You can turn this whole thing around by eating far fewer carbs. Personally, I eat a Very Low Carb and usually just One Meal a Day (OMAD) I also use Intermittent Fasting (IF) from time to time. I’ve lost a lot of weight (180 pounds) and put my T2DM (Dx 1986) in remission. I have very good blood markers and I feel great. I did it without hunger (because fat is satiating), and without exercise. You can too.

Retrospective #468: Drink SuperBeets® for a “boost”?

SuperBeets®? Have you seen the TV commercial? Dana Loesch, a radio and TV host, pushes a powdered beet concoction that promises to make you “more healthy.” “Beets contain a nutrient that increases your own natural energy,” she says, but she doesn’t say what that nutrient is. It’s sugar. Fact: the body can only get energy from sugar (glucose) or fat (fatty acids and ketones from triglycerides), plus, by gluconeogenesis, a little glucose from protein and fat. But you can bet your sweet bitty that the “natural energy” you get from beets is sugar, not fat (or protein).

Don’t you think it’s curious that the TV commercial doesn’t even mention “sugar”? Neither energy source (fat nor sugar) is mentioned in the 1-minute TV commercial. Instead, the commercial extols the benefits of the “boost” you’ll get from “increasing your nitrous oxide level.” It suggests, by inference, that this compound is one that your body lacks and needs more of to be healthy. Did you know that? No? It’s news to me, too.

I did some research, however, and discovered that 20% of the world’s sugar production is derived from BEETS. Sugar beet production is mostly from temperate climates. The United States, Russia and France are the top producers, with the U.S. accounting for about 12%. The remaining 80% of world sugar production is from CANE sugar, grown in tropical places like Brazil, India, China and Thailand. The U.S. produces only about 1.5% of the world’s sugar cane.

Nitrous oxide (N₂0), also known as “laughing gas,” is an analgesic and a weak anaesthetic. The inhaled gas has a half-life of 5 minutes. I was unable to learn how long a “nitrous oxide level” persists in the blood, but – a much more important fact – glucose persistence in your bloodstream, depends on your degree of INSULIN RESISTANCE.

With normal blood sugar metabolism, the pancreas will produce insulin as needed to convey glucose (the “sugar” in the blood) from the food you eat to your destination cells. There, insulin receptors are supposed to open up to receive the glucose. This quickly produces a spike of energy, and, normally, your blood sugar quickly returns to normal.

If, however, you have any degree of Insulin Resistance, the receptor cells will resist opening. Your pancreas then sends more insulin “to help” until the cells eventually open, your blood sugar crashes, and you need a “boost.”

So, if you have insulin receptors that have been conditioned by a lifetime of eating processed carbs and sugars – both cane and beet, and you drink SuperBeets® for a “boost,” your blood sugar will go high, and stay high, for a long time. But who cares? With SuperBeets®, your nitrous oxide level will be high for 5 minutes. Woo hoo!

One online testimonial said, “Within 30 minutes of taking it, I felt the difference,”. That makes sense. That’s the sugar, stupid! Sugar IS a source of quick energy. It gets into your bloodstream in minutes. And with Insulin Resistance, it will cause blood sugar to “boost” and stay high longer. You will feel “the difference” You’ll also feel the crash!

Thus, Dana says she takes SuperBeets® multiple times a day: “in the morning, at the gym, in the afternoon as a pick-me-up.” Can you imagine? If she has any Insulin Resistance at all – and most adults, especially older ones do – her blood sugar curve would be a rollercoaster of ups and downs all day long. Spike, crash, spike, crash…endlessly, for so long and as often as she gets a concentrated hit of beet sugar “as a pick-me-up,” and for whenever she wanted to “feel the difference.” Is that what you want? To be more of a “SUGARHOLIC” than you already are?

But if that’s not what you want, you could try a “lifestyle modification” and give your pancreas a rest. If you eat less “sugar,” your pancreas will not need to send a double dose of insulin to make the receptor cells work. This will help preserve your pancreas’s capacity for years to come, AND YOUR ENERGY LEVEL WILL NOT FLUCTUATE AS MUCH. It will remain stable and flat while your body burns FAT for energy. Fat doesn’t need insulin to give you energy. It’s actually absorbed through the lymph system and then into your blood and keeps your energy level high and level.

If you feel the need for a “boost,” ask yourself, am I already addicted to sugar? If you answered “yes,” then ask yourself, why on earth would you choose to add more sugar to your diet? Think about that.

Retrospective #467: It’s not fair!

It’s not fair. It’s not fair that, “The weight reduced individual will be requiring about 20% less (sic) calories per day relative to somebody of that weight who’s never lost weight would eat…in order to keep at that weight.” That’s what Rudolf Leibel, MD, Co-Director of the New York Obesity Research Center at Columbia University Medical Center said in “Choices,” one of 4 hour-long videos in the 2014 PBS series, “Weight of the Nation.”

“Individuals losing weight are not metabolically the same as they were before they lost weight,” Dr. Leibel said. I know. It’s not fair, but that’s the way it is…if you believe “a calorie is a calorie,” as Dr. Leibel apparently does. You will be consigned to accept this depressing fact and live with it. Worse still, you must be resigned to either 1) be fat because you will naturally want to eat as much as the person “who’s never lost weight” (because they don’t have to), or 2) you will eat 20% fewer calories and be hungry all the time. Your choice! (if you believe this line of thinking).

Dr. Leibel’s example: “Consider two individuals – same gender, same age, exactly the same body weight – one of whom is at that body weight as a result of let’s say a 10 or 15% weight reduction, the other who’s been at that weight for their entire adult life. If that reduced weight individual goes out to lunch with her friend, and they both order the same meal, that will represent 20% overeating for the weight-reduced individual, and be quite normal for the individual who’s not in that state. Twenty percent might seem like a little, but 20% excess calorie intake a year will account for the inexorable weight gain.” There, he said it again: “excess calories.”

But what if “calories don’t count”? I’m not joking. If you haven’t heard this before, just Google it. I got 20 million hits, many, on the first few pages, from sites that I respect. But I don’t need to search the Internet to know that. I don’t need to “count” calories (or eat 20% fewer) to keep the weight off or not regain the weight I’ve lost. I know I can do that by changing the foods I eat; by eating fewer carbohydrates, especially processed carbohydrates; by eating high quality proteins and fats instead. They will be more satiating, and I will naturally eat less without hunger (because, when my blood sugar and insulin levels are low, my body is using it’s own fat for fuel and is in energy balance).

Sound too simple? Too good to be true? Well, if you don’t want to accept this, then you are welcome to wallow in self-pity and eat the “balanced diet” that the USDA and BIG PHARMA and the medical establishment dictate. You can ignore their conflicts of interest. You can also ignore your glucose meter and what is best for YOUR health. You can follow the HHS/USDA Dietary Guidelines for Americans, which continues to closely mirror the catastrophic “diabesity” epidemic trendline since they were first published in 1980, following the dictates of the “Dietary Goals” of 1977. 

You can also rely on the American Heart Association’s exhortation since 1961 that you avoid saturated fat and dietary cholesterol and instead eat their recommended highly processed vegetable and seed oils produced by the same USDA-subsidized AGRIBUSINESSES that made the trans-fat laden Crisco and corn-oil margarines. It’s your choice.

So, whom are you going to believe, me or your heart doctor? ;-) Okay, THAT’s not fair either. If you already have heart disease, I won’t blame you for following your specialist’s advice, even if he or she doesn’t know sh*t about nutrition. But, just for laughs, I challenge you to ask if they know 1) that in 2014 the Dietary Guidelines Advisory Committee declared “dietary cholesterol…is no longer a nutrient of concern for over-consumption” and 2) that Ancel Keys, the author of the “diet-heart hypothesis,” said later in life “we’ve known that all along. Cholesterol in the diet doesn’t matter at all unless you happen to be a chicken or a rabbit.”

Then, there’s also this quote of “updated findings” from Dr. William Castelli, Director of the famous Framingham Study, published in Archives of Internal Medicine: “In Framingham, Massachusetts, the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower people’s serum cholesterol. . . we found that the people who ate the most cholesterol, ate the most saturated fat, and ate the most calories weighed the least and were the most physically active.” As I said, whom are you going to believe? Me, the 2014 Dietary Guidelines Advisory Committee, the Director of the long-term, highly respected Framingham Study, or your doctor? Confounding, isn’t it?

Retrospective #466: Want help getting into a size 10?

A year or so ago a friend who’d noticed how much weight I’d lost asked me how I did it. I told her, “Very Low Carb.” Like virtually everyone, she admitted she didn’t have a clue about the fine points of what a carbohydrate is and asked for a little guidance. Totally unaware of how much travail it would cause us both in the ensuing weeks, I unwittingly jumped at the opportunity to mentor her…but we succeeded. Here’s how I discovered it.

I saw her at a garden party last summer. When she asked if I had noticed how much weight she’d lost, I replied, “No, but I noticed how good you look in that dress.” She smiled. “I’ve lost 26 pounds, 1 dress size,” she said. “It’s a size 10.” “I would like to lose another couple of pounds,” she continued, “so a fitted dress would be a little more comfortable through the waist. I’m not shooting for a size 8” though,” she chuckled…which brings me to the subject of this post: MODERATION.

I hate the concept of moderation. I’m more of an “all in” type of person. Too often “moderation” is used as an excuse by those who reject radical lifestyle change. “Moderation” is an ideology in itself, but it’s often used as a response to importunate demands for radical change. Just because I lost over 180 pounds and kept most of it off is no reason to think that is the only way to lose weight. This is also true if 1) you don’t need to or want to lose so much weight and 2) you are cut from a “different cloth,” as my friend and perhaps the majority of the overweight people in this nation are.

My friend taught me this lesson. She of course is happy that she lost 26 pounds. She would be happier still if she lost another 6 or 7, which she now knows how to do. In her case, 26 pounds was over 20% of her starting weight, so that IS a singular achievement. Another 6 or 7 pounds would be 5% more of her current weight!

Why the opportunity to mentor my friend was so vexatious is that, to adopt a MODERATE approach to eating LOW CARB (rather than the extreme approach of VERY LOW CARB that I used), required first, a lot of education and then, a lot of “negotiation.“ My friend leads a very intense, edgy lifestyle, constantly creating lots of “on the edge” situations as part of her work. She writes novels. As a result, she’s inured to living somewhat “on the edge” herself.

A lifestyle that is fraught with anxiety and risk-taking is bound to be a strain on one’s psyche. For balance, such a lifestyle likewise requires rational thinking and counter measures to deal with the day-to-day exigencies. And to deal with this lifestyle, eating becomes both a driver and a crutch. Comfort food is an integral part of her lifestyle, and snacking is an integral part of her eating pattern. Therein lay the challenge.

Snacking is antithetical to a sound Low Carb Eating Plan, but giving up snacks was off the table – not negotiable! It was integral to her modus operendi. Therefore, all that remained was the Low Carb part. Beyond that, the education was pretty simple: She told me what she ate, and I gave her a basic education about which things she ate were bad choices: carbs in general but both the “complex” carb type and the simple sugars in particular. And that was it!

I’ve always scoffed at the concept of negotiating with a patient as the ADA’s clinical practice guidelines counsel. But in this case, I learned first-hand with my “patient” – with snacking being a part of her working lifestyle, which I totally understood and had to accept – a workaround would be necessary. And it was.

It took dozens of emails over several weeks, including countless recitations of the same principles to refute the same “scientific” articles she sent me which advocated for another Way of Eating in direct counterpoint to the Low Carb way. But eventually we modified her “Eating Plan” sufficiently to where she started to see a difference on the scale.

The back and forth ended one day when I gave up on repeatedly defending the science of Low Carb eating. We didn’t “talk” for months afterwards, so I was delighted when we met at the garden party, and she asked me if I had noticed her weight loss. That’s when I said, “No, but I did notice how good you look in that dress.” I think we both felt pretty good about that. I think her doctor saw it in her lab tests too (A1c and cholesterol). Of course, I would like to see her go for that size 8 dress. She knows how now and could get there by simply going back and doing “more of the same.”

Retrospective #465: Diabetic neuropathic complications

If the subject matter of this post turns you off, good! I’m going to get personal, and I’m not especially fond of the idea of your reading about my bladder dysfunction. But the truth is, my urologist thinks, and my internist agrees, that as a 32-year type 2 diabetic, I may have begun to show a sign of diabetic neuropathy. His Dx: that I have a neurogenic bladder that appears to be responsible for a worsening eGFR. What’s that, you ask?

An eGFR, “estimated glomerular flow rate,” is a lab test of kidney function. It is a common marker for Chronic Kidney Disease (CKD) and is evaluated on a scale of declining kidney function (5 stages ending with end-stage kidney disease and renal dialysis. That “complication” is called nephropathy, one of three possible microvascular complications  of long-term type 2 diabetes. The third is retinopathy (leading to blindness).

So, what is a normal eGFR? According to Wikipedia, the National Kidney Foundation defines, “a normal GFR for adults as greater than 90 mL/min/1.73m².” “Because the calculation works best for estimating reduced kidney function, actual numbers are only reported once values are less than 60. Normal GFR values are largely over 60 in healthy subjects, at least before the age of 70 years. However, we know that GFR physiologically decreases with age, and in adults older than 70 years, values below 60 could be considered normal.”

My doctor began to request eGFR tests for me in 2011, one month before I turned 70. For three years, the next nine tests were all ≥60. Then, starting in 2015 (at age 73), 5 of the next 7 were below 60 (mostly low 50s); then, last summer I had a 43, which repeated at 47 and 45 (average of 3 = 45). I also wanted to know why I peed just a little and so often, so my urologist undertook a series of tests and examinations. We think we now know the answer.

I have a very large bladder – over a one-liter capacity – and it doesn’t completely empty despite the urethra having a clear passage through the prostate. The reason, apparently, is neuropathy: the muscle that normally contracts the bladder to make me “void” isn’t getting a signal to contract from my nervous system. Hence, the enlarged bladder and the frequent urge to urinate small amounts that I’ve observed since the beginning of the year. The urologist ordered a prescription to relax the muscle in the neck of the bladder, but it didn’t help.

As a result, his thinking goes, when my enlarged bladder is really full, and not emptying much, urine backs up the ureters to the kidneys; and puts back pressure on the kidneys. And this is beginning to cause the reduced kidney function (lower eGFRs). My internist concurred and added, for effect, that back pressure affects both kidneys, and I only have two! He also stressed that I must drink plenty of fluids because dehydration also causes kidney damage.

My urologist has now twice suggested that the best option for me at this point is self-catheterization. I have reluctantly come to the same conclusion. Ugh! My plan is to live to be 100, and to do that I’ll need my kidneys, such as they are. When I was in my 40s, the idea of taking a pill every day for the rest of my life was anathema. Now, I take a handful twice a day. So be it. At least I can say I am “otherwise healthy,” knock on wood.

The “plan” (the urologist’s ploy to get me to start) was to have me catheterize myself three times a day for a few weeks and then do another eGFR. If my kidney function improves, that is, if my eGFR increases, as he thinks it may, then I will have to continue with catheterization from that point forward (until I get to be 100), to preserve the benefits. Apparently, no other remedy is available for a neurogenic bladder.

Two subsequent eGFRs, performed at two-week intervals after catheterization began, were improved (53 and 55). A third, 2 months later, was, alas, back down to a disappointing 47. So, we’ll just have to “wait and see.”

Meantime, the message here is to take notice of changes in your daily habits (like frequency and amount of urination) and discuss it with your doctor(s) before you too have no choice but to “siphon the python.” Happy New Year!

Note: This blog was originally posted in January 2019. Since then, my eGFRs have been stable and above 45, and I continue to catheterize 3 times daily…in case you’re interested.

Retrospective #464: “She was only 75.”

Penny Marshall died a few years ago at age 75…of “complications of diabetes.” A commentator lamented, “She was only 75.” Nobody explained the pathophysiology, which was correct, I suppose. An obituary is about a person’s life and accomplishments. Penny Marshall was brilliant in “Laverne and Shirley” and as a movie director. “A League of Their Own” is one of my favorites, but when I saw a picture of her, I knew she was probably diabetic. She was fat.

I don’t want to blame her for that, although I regularly hector and cajole my readers for the very same thing. I do that because, like the rest of us, she probably followed “doctor’s orders,” especially when she knew she was sick and presented with unmistakable markers of metabolic disease. But when we simply gain a little weight over the years, and have no symptoms, we (including the doctor!) mark it up to “eating too much and moving too little.” We are told “diet and exercise” is the way to drop the weight. We try to lose again and again, and we fail…again and again.

So, it’s our fault. We heeded the doctor’s advice, and we tried. We went to the gym (maybe) and tried to eat less of the foods the doctors and the medical associations and the government public health establishment told us not to eat, and we lost some weight. But we were always hungry, and eventually we lost resolve and gained it back. We failed. We did as we were told, and we failed. Over and over again. Is anyone thinking of the famous Einstein aphorism?

Einstein said: “INSANITY IS DOING THE SAME THING OVER AND OVER AND EXPECTING DIFFERENT RESULTS.”

That’s why, I suppose, there are so many different diets out there. It’s so we don’t see ourselves as doing the same thing over and over again. But, don’t you see, we are, really. WE ARE GETTING THE SAME RESULT! It’s insane.

All these “approved” diets have different names and other things that make them seem different, but they are really much more similar than we think. They are mostly “BALANCED.” What does that mean? That means that they include the ratios of fat, protein and carbs (the “macronutrients”) that government and the medical establishment have recommended, WITHOUT SOLID SCIENTIFIC EVIDENCE, for over half a century.

These ratios are on the Nutrition Facts panel on every box and bag that we buy at the supermarket. The daily amount recommended for every adult WOMAN is 300g of carbohydrates, 50g of protein, and +/-65g of fat, mostly polyunsaturated fat (PUFA), from “vegetable” (seed and grain) oils. That translates to 1,200kcal of carbs (@4kcal/g), 200kcal of protein (@4kcal/g) and 600kcal of fat (@9kcal/g).

Here’s the truly shocking Percent Daily Value (%DV) of that 2,000kcal diet that “women of a certain age” are thus counseled to eat: 60% CARBOHYDRATE, 10% protein and 30% fat. Did you know that? THAT’S 60% PERCENT CARBS! And for MEN the percentages are the same; it’s just that we’re allowed 2,500kal a day, as follows: 375g carbs, 62.5g protein and 83g fat. That’s still 60% PERCENT CARBOHYDRATES, MEN! Is that insane, or what?  Bonus trivia: this is how the beef industry fatten beeves on a feedlot. No, I’m not joking.

That’s why Penny Marshall was fat. Not because she ate too much and didn’t exercise enough. Her obituary didn’t say that. It didn’t have to. The simple statement “complications of diabetes” said it all. Let that sink in. Then, ask yourself, was it a Macrovascular complication (stroke, heart failure, or old-fashioned MI (heart attack), increasingly common with diabetics, or perhaps a Microvascular complication? Nephropathy: end-stage kidney disease, with dialysis, or neuropathy (with amputations), or retinopathy (with blindness).

In any case, Penny Marshall had a choice, if she had known about it. And you still have, a choice. TYPE 2 DIABETES IS A DIETARY DISEASE. It is the result of eating a “balanced” diet that includes way too many processed carbs and foods with added sugar and processed vegetable oils. What does that have to do with being fat? When you greatly reduce the amount of carbs in a meal, starting with “breakfast,” you allow your body to switch to burning its own fat for energy…so you won’t be hungry all the time. You won’t eat as much and put on those extra pounds. In fact, you will quickly start to lose weight. Have just eggs, bacon and coffee for breakfast. No cereal, no toast, no fruit, no yogurt!

Retrospective #463: “You eat healthy, take statins…”

The TV commercial begins, “You eat healthy, take statins…” and then goes on to describe a new class of drug designed, “to lower LDL-C when added to a high-dose statin” (my emphasis). That’s what gets me riled. Folks, if you’re “eating healthy,” unless you have a very rare condition called “familial hypercholesterolemia,” you shouldn’t need to take a statin, much less an added drug in addition to a high-dose statin. Geeez…

Of course, this claim all revolves around what you (or they, the drug maker) call “eating healthy.” The drug maker will claim, rightly, that their “eating healthy” is what you have been told to eat by the USDA/HHS, creators and promotors of the Dietary Guidelines for Americans from 1980 through 2015, including the upcoming 2020 update. A pictogram that describes it in a nutshell is at ChooseMyPlate.gov. It is endorsed by the AMA, the AHA, the ADA, etc., etc.

So, if you “eat healthy” in the way they prescribe, you very well may need to take a statin. And if it doesn’t lower your LDL-C sufficiently to satisfy the Total Cholesterol and LDL-C “Standards of Medical Practice” for a lipid profile, established by the tragically misguided practices of those government/medical entities, you’re going to be cajoled relentlessly to start taking a statin, and if a high-dose statin doesn’t “do the job,” to start taking this new drug.

In 2002, I had been a diagnosed a type 2 diabetic for 16 years and was still eating the Standard American Diet. I was on 3 classes of oral antidiabetic drugs (maxed out on 2), and my blood sugar was still “out of control.” To help me to lose weight, my doctor suggested I start eating Very Low Carb (VLC), i.e. just 20g of carbs a day. The first day I had a hypo, and 2 more that week. My doctor took me off 1 drug and cut the other 2 in half TWICE. In 9 months I lost 60 pounds.

Then in 2003, following the medical Standard of Care, my doctor started me on a high-dose statin and in no time got my LDL-C down to “target” (<70mg/dl). In 2006 I rededicated myself to VLC and lost over 100 pounds in a little over a year. By 2008 I had lost 170 pounds total and lowered my blood pressure to 110/70 on fewer BP meds.

Eating Very Low Carb also transformed my lipid panel. While my Total Cholesterol (TC) and LDL-C remained about the same, I doubled my HDL-C and lowered my triglycerides (TGs) by two-thirds. When my doctor saw these lipid panel outcomes, he used his clinical judgment and took me off statins completely. That was 2008, 12 years ago. I still eat VLC most of the time, and my latest lipids were TC 189; LDL-C* 83; HDL-C 92; non-HDL 97 and TG 56mg/dl.

* Calculated by Quest using Martin/Hopkins; previously Quest calculated LDL-C by the Friedewald method.

A chart below illustrates my TC and LDL-C while off, then on, then off again a statin, from 1980 to the present.

So, I think it’s reasonable to ask, “Is your ‘eating healthy,’ (the way the USDA/HHS and the AMA, AHA and ADA have been telling you to do all your life), the reason your doctor has you on a high-dose statin and is now twisting your arm unremittingly to take yet another drug to lower your LDL-C?” I think so. And my doctor apparently agreed. Do you think that if you changed the way you eat, you wouldn’t “need” to take a statin? Think about that!

Retrospective #462: Insulin Resistance and the TG/HDL Ratio

“Dr. Jay” is Jay Wortman, MD, a Canadian clinician, Very Low Carb advocate and political activist who I first found in 2012 at Franziska Spritzler’s old Low Carb Dietitian. Both he and I are among a very good list of links and resources there. That was only two years after I had started blogging, so when I visited Dr. Jay's Blog, I left a comment on his “The Story So Far….” And, as shameless self-promotion, I also left a link to my blog’s website. It has since garnered a few hundred hits. I also get lots of page views from Franziska’s blog list.

Jay Wortman has become very active on Facebook. A while ago when I offered wishy-washy advice to a newly diagnosed type 2 looking for help on a popular Facebook group, Dr. Jay intervened with a reply comment to mine. He blasted my lame advice, telling the hapless newbie to face facts. The newbie had Insulin Resistance and was therefore Carbohydrate Intolerant. I was embarrassed by my half-baked input, but very grateful he is lurking, or more likely, following the group. Dr. Jay is both passionate and selfless, and dedicated to helping. 

Dr. Wortman also keeps up with the most relevant medical research. He recently posted on Facebook this PubMed Central (PMC) mouse study, “The Failing Heart Relies on Ketone Bodies as Fuel.” The study concluded, “These results indicate that the hypertrophied and failing heart shifts to ketone bodies as a significant fuel source for oxidative ATP production.” Translation: the ketogenic diet is good for the failing heart, in mice.

Another Facebook post by Dr. Jay is this study from Malaysia appearing in PMC. Looking for “an easy to use, precise and low-cost diagnostic test to predict Insulin Resistance,” 271 overweight and obese children were “stratified by tertiles using the homeostasis model assessment (HOMA), a good surrogate for the gold standard for measuring IR, the hyperinsulinemic euglycemic clamp.” “The children were analyzed for fasting glucose, lipids, insulin and waist circumference. The children were then stratified by tertile of TG:HDL-C ratio.”

The study’s conclusion: “the odds of having IR was about 2.5 times higher (OR=2.47, 95%CI, p=0.01) for those in the highest tertile of TG:HDL-C ratio. Hence, TG:HDL-C may be a useful tool to identify high risk individuals.” Dr. Jay’s endorsement/imprimatur of this conclusion was, “I calculate this for all my patients.”

Below is a chart of my 82 TG/HDL-C ratios since 1980. The first 17 ratios were while I was eating the “Standard American Diet” (SAD) and, since diagnosed in 1986, treated for type 2 diabetes with antihyperglycemic drugs. The last 65 ratios are since I began to eat Very Low Carb in 2002. A TG/HDL ≤ 1.0 is ideal, a ratio of ≤2.0 is good, anything over 3 is “indicates significant risk of heart attack and stroke.”  Note almost all of mine since #17 are ≤1.0.

This metric has been in use by non-cholesterol-phobic physicians for years. I wrote about in 2011 in my Retrospective #27 “...the strongest predictor of a heart attack.” I hope more physicians, like “Dr. Jay,” start to routinely use it.

Retrospective #461: Very Low Carb is the Basic Precept

The best diet for a type 2 or pre-diabetic to control their blood glucose is Very Low Carb (VLC). How many grams of carbs you eat will depend on your degree of Insulin Resistance (IR). Your meter will tell you. Then, the number of carbs you eat will be up to you. How much do you want to mediate your condition? Do you want to put your diabetes in remission, or do you just want to let your doctor manage it as you go on with your old diet?

In the last 16 years I have tweaked how I eat a lot. My doctor started me “cold turkey” on Atkins Induction (20 carb grams a day). I few years later I switched to Richard K. Bernstein’s 30 grams a day (his 6-12-12 program). I transitioned to LC-HF (low-carb, high-fat), then to VLCKD (“keto”), and finally VLC with lower protein and moderate fat, to allow my body to burn its own fat, while I fasted or had one-meal-a-day (OMAD) and was “fat-adapted.” All of these Ways of Eating have one thing in common; the basic precept is Very Low Carb.

Besides always being fundamentally Very Low Carb, it has also always been Moderate Protein. It is not high protein as some would have you think. People who say “high protein,” are thinking negatively in two respects: 1) They think “high protein” is harmful to the kidneys and 2) they are afraid to call it or think of it as “high fat,” which it is. High fat, especially saturated fat, they think, is harmful to the heart, which it is not.

With respect to PROTEIN, a moderate level means from 15% to 30% protein, depending on the carb and fat calories. Mine has been 20% for many years. Second, only a diet that is higher than 30% protein of total calories (including body fat burned), might be harmful to the kidneys and then only if you already have kidney disease.

Fear of FAT is not supported by sound science, as the world is just now coming to realize. We have all been unwitting subjects in a 60-year, world-wide, low-fat, public health experiment. In this respect, I hope you’ve noticed that the 2015 Dietary Guidelines have quietly dropped the “30% and lower” target for fat in their recommendations. You probably didn’t notice that the Dietary Guidelines Advisory Committee told the full committee that “cholesterol is…no longer a nutrient of concern for overconsumption.” Cholesterol accompanies saturated fat in animal foods, and you no longer are being guided to limit your CHOLESTEROL to 300 mg a day! Eat eggs! Eat shrimp! Enjoy!

Unfortunately, the Guidelines still focus – in fact they have doubled down – on the dietary recommendation against SATURATED FAT, found mostly in animal products (butter, ghee, lard, tallow) but also in coconut oil. They – ahem, the United States Department of Agriculture, the co-authors of the Dietary Guidelines with another government agency, HHS – want you to “shift from eating solid fats to oils,” specifically the highly processed grain and seed oils grown, manufactured and “baked into” foods, literally and figuratively, by American AgriBusiness. Anyone see a conflict?

Basically, a diet that is very low carb, moderate protein and high fat – or moderate fat if you are fat-adapted and need to lose more body weight with fasting or just calorie restriction – is going to work for you to manage your blood sugar and to lose weight without hunger. When my doctor started me on Atkins Induction 18 years ago, for weight loss, it worked. But we were both surprised that I had hypos for a week until my doctor told me to stop taking virtually all the anti-diabetic meds he had me on. I still take Metformin. And eventually I lost over 180 pounds!

My blood lipids also improved dramatically, cutting my triglycerides by 2/3rds and doubling my HDL-C. And, with weight loss, my blood pressure went down, as did my systemic inflammation levels (hsCRP). I am so much healthier today than before, and I feel so much better. It all began with VERY LOW CARB. It is the basic precept for type 2s.

My apologies to my regular readers of this blog. I’ve told this story many times; however, since my columns cover a wide range of subjects and aren’t indexed, the majority of my readers find me through a “Google” search.  If that includes you, I hope you will return often and make this one of your favorite sites, or even become a “follower” and send a hyperlink to a friend. I accept no ads because I have no products to promote or sell – only nutritional advice and encouragement for type 2s and pre-diabetics.

Retrospective #460: The Blind Leading the Blind

No offence intended if this “microaggression” offends any blind person to whom this column is read, but that was my reaction to a “workshop” I attended a while back, conducted at a local hospital by two state-trained Registered Dietitians (RDs). There were 13 attendees all looking for help to deal with their type 2 diabetes.

The workshop began with a brainstorming session in which each person was asked how they felt about being a type 2 diabetic. The moderators – I’ll call them Tweedledum and Tweedledee – dutifully wrote the feelings down on a mammoth 20 x 30-inch Post It. Virtually everyone expressed negative emotions, among them anger, confusion and frustration. I was last to be asked, and I said I had no such negative emotions because my type 2 diabetes was now under control. My last A1c was 5.0%, and the only diabetes medication I take is Metformin.

I was then asked by Dee, reasonably, why I was attending the workshop. I explained that I had seen an invitation in the newspaper inviting type 2 diabetics to attend. I had been a type 2 for thirty-four years, and my diabetes progressively worsened until I was taking 3 different orals meds – maxed out on 2 – and my fasting blood sugars were still out of control. Then, 16 years ago, to lose weight, my doctor suggested I try a Very Low Carb diet he had read about and tried himself. The first day, to prevent hypos, he had to take me off 1 med and within the week he cut each of the other 2 meds in half TWICE. Over several years I lost over 180 pounds and I wanted to share the good news.

Although I mentioned  NYT Magazine cover story my doctor had read, nobody – neither Dum nor Dee nor anyone taking the workshop – expressed any interest in how I accomplished what I did. Of course, they weren’t there to listen to me. They were in this group because their health-care providers apparently had sent them there to help them deal with their anger, confusion and frustration. The free book that everyone got said it all: “Living a Healthy Life with Chronic Conditions.” In other words, give up hope of reversing your T2D; just get used to it.

I really did feel sorry for the hapless participants, each with different issues but one thing in common: Type 2 Diabetes. They were all victims of the current healthcare system. The course syllabus, from which the workshop facilitators READ VERBATIM, was based on the Chronic Disease Self-Management Program (CDSMP) developed by Stanford University. The homework assignment for workshop #2 was to read the “food guide” in the text and learn about “healthy eating.”  It is based on is the “Dietary Guidelines for Americans,” as illustrated in the book by ChooseMyPlate.gov, and the American Diabetes Association’s, “Create Your Plate.”

The Dietary Guidelines “Choose My Plate’ plan is ¼ fruits, ¼ vegetables, ¼ grains and ¼ protein, with dairy in a bubble. No fat. The ADA’s “Create My Plate” plan is ½ non-starchy veggies, ¼ starchy foods, and ¼ meat or meat substitute, with 8 oz non-or-low fat milk. Clearly the US Department of Agriculture and the American Dairy Products Association had a hand in developing these essentially identical plans, helped by Big Pharma and Big Food Producers. How all this corruption co-exists is explained in “Root Causes” by Jason Fung, MD.

The penultimate task of the workshop was to come up with an individual Action Plan for the coming week. Mine (I was last again) was two 36-hour total fasts, on alternate days, until I lost the weight I had gained since my last annual doctor’s visit. On the other 5 days I would eat Very Low Carb/One Meal a Day (VLC/OMAD). 

At the conclusion of class, we were all asked for our impression on how things had gone. I think Dum and Dee were hoping to get feedback that we all felt better after having attended our first group therapy session. Once again last to speak, I commented that I thought it odd that most people’s “Action Plans” were to exercise more. Doesn’t everyone realize: “DIABETES IS A DIETARY DISEASE.” Tweedle Dum replied with a non sequitur: “Well, everyone’s different.”

If you click on both “Plate” links above, you will get a visual image you won’t forget. Americans have been following these guidelines, and the incidence of diabesity has skyrocketed. Sadly, no one in this workshop will have any hope of self-managing their disease. Our government has failed them with bad dietary recommendations. I think the only thing that this “self-management” program is designed to achieve is acceptance of their feelings of failure. That is truly sad.

Retrospective #459: My new favorite snack

I’ve been mentoring a recently diagnosed type 2 about what and when to eat, and not eat. I’ve told him that when you eat Very Low Carb (VLC), you won’t be hungry much, and you should skip meals if you’re not hungry. When you eat VLC, your blood glucose drops and your blood insulin drops too, so you can access and burn your own body fat. That’s why you’re not hungry. Your body is being fueled by your own stored energy.

So, in general, you won’t need to snack for energy, but they are other reasons we snack. We all (most of us) do it, some of us habitually. I usually snack in the late afternoon, with a beverage before supper, and when I do, my favorite new snack is celery with anchovy paste. Celery is low calorie – just fiber and water – so it’s filling. On each bite I add a dollop of paste, squeezed directly from the tube, for savor. But when my mentee tried it, he said, “It’s salty!”

It is salty, of course. Very salty. That’s why I like it. But to a newbie to Low Carb, salt is still verboten. For decades we have been told to avoid fat, especially saturated fat, and cholesterol, and salt. Now we know that the government’s advice to avoid fat was a wrong. As proof, the 2015 Dietary Guidelines, for the first time, omitted the recommended 30% limit on fat. It’s now officially okay to eat more fat (in order to eat fewer carbs); it’s just not okay to eat SATURATED fat.

But from my POV that just takes us from the frying pan into the fryer (LOL). The alternative to saturated fat is unsaturated fat, either monounsaturated, the “good” fat found most commonly in olive oil and avocados, or polyunsaturated (PUFAs). PUFAs are highly refined and processed “vegetable” (seed) oils – corn oil, soybean, Canola, and sunflower oil, etc. – that easily oxidize when exposed to light and heat (the fryer). Think French fries.

Government is also slowly backing away from warnings about dietary cholesterol, found only in animal foods. Again, starting with the 2015 Dietary Guidelines, there is no longer a 300mg a day limit on dietary cholesterol. However, the recommendation of the Dietary Guidelines Advisory Committee, that “cholesterol is no longer a nutrient of concern for overconsumption,” was largely ignored by the full HHS committee. They are, however, slowly coming to accept that, if we don’t eat it, our livers will make all the cholesterol our bodies need. Think vegans. They don’t eat any!

So, what’s wrong with eating salt? Nothing, unless you believe that the Public Health recommendation that everyone should eat less salt to protect the very few who have a rare genetic sensitivity to high levels of salt. The 2015 Dietary Guidelines have, however, also DROPPED the 2010 recommendation that Americans “reduce daily sodium intake to less than 2,300 milligrams (1 tsp salt) and further reduce intake to 1,500mg among persons who are 51 and older and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease.” Think about half the U.S. population!

In his series “Shaking Up the Salt Myth,” Paleo blogger Chris Kresser wrote an article, “The Dangers of Salt Restriction,” about a study in JAMA in 2011 that “demonstrates a low-salt zone where stroke, heart attack and death are more likely.” He concludes, “These findings demonstrate the lowest risk of death for sodium excretion is between 4 and 5.99 grams per day.” So, the lowest risk of death is associated with consuming from 267% to 399% more sodium than type 2s or hypertensives or older adults were being “guided” to eat. I’ve been writing about salt since 2012. My column #74 cites Kresser and several other resources as well.

●        Gary Taubes, “The (Political) Science of Salt,” and “Salt, We Misjudged You,” both also cited in #74.

●        Eric Topol, MD, Editor-in-Chief of Medscape Medical News: “Dear Medscape Readers” (my #248)

●        Then there’s this recent rant on the “salt scare” by Jason Fung, MD/IDM. It’s a no-holds-barred tirade!

●        For “Tips and Tricks” on why Low Carbers should eat more salt to maintain electrolyte balance, Michael Eades, MD, has this link to his blog. Eades also explains the physiology.

Please read these links about salt. Losing weight and improving your general health and lipid profiles on a VLC diet will be more beneficial than living with mild hypertension, under control.  My doctor believes this, emphatically.

Retrospective #458: Is it time to clean out the pantry?

If you’re new to eating Low Carb, and/or specifically Very Low Carb (as I eat), and you’re human (as I am), you probably have a couple of challenges ahead of you. If you live alone, you’re lucky, at least in this respect: The only food in the house, then, would be the food you bought. You have no one to blame but yourself for your choices.

Of course, if you blame someone else for the food choices they made, by buying food you’re trying not to eat, you have another problem: taking responsibility yourself for the food you decide to put in your mouth. But we’re all human, as I’ve said, and I’ll have to admit, it is sometimes hard for me not to eat the food I’m trying to avoid. I have a problem is it’s just sitting in the pantry, especially in OPEN boxes, containers and bags, or worse JUST SITTING ON THE COUNTER. Most of my neurotransmitters still work. Have you heard about the cephalic response?

But the fact is, “if you live alone…the only food in the house is the food you bought,” including a vestigial accumulation of “before” foods. In transitioning from eating the Standard American Diet (SAD) to eating Very Low Carb, you still have goods in your pantry (and frig) that remain from those halcyon days of yesteryear when you ate processed foods and sweets to your “heart’s content” – wow, is that a misnomer. More correctly – to satisfy your brain’s addiction to foods that were developed and produced to addict you to them. When you blamed yourself for eating that food, you called it a “craving.” It’ll be awhile before you’re weaned off them and realize you no longer need them.

Until that time, you need to take steps to reduce the temptation to stray from the new Way of Eating that you have set for yourself. This Way of Eating may seem difficult at first, and confusing too, until you learn when and what to eat, and not eat, but you will eventually sort this out. When you follow a Very Low Carb (VLC) Way of Eating for a period of time (a few days or maybe longer), and you lower your blood insulin and deplete your liver glycogen supply of stored glucose, you will transition to being a “fat burner.” For that point forward, you will not be hungry.

But, if you’re like me, that doesn’t mean you won’t be tempted to eat carbs, both the highly processed ones and sweets. So, the best defense is a strong offense. You need to take charge. Clean out your pantry and frig of all things that might tempt you when you “raid” the kitchen looking for something to put in your mouth.

When you were a “sugar burner,” you were probably told you should eat 5 or 6 times a day, that you needed these infusions, or “snacks,” for energy.  That was true. When you followed the Standard American Diet (SAD), which is 55% to 60% carbohydrate, and you have Insulin Resistance (IR), your blood sugar goes up and down like a roller coaster, but your blood insulin level stays high (because of your IR). And because your blood insulin is still high, you don’t have access to your body fat for energy. So, you need to snack on carbs (or fat), for that “energy boost” (energy balance).

But when you eat Very Low Carb, you’re not hungry. You have access to body fat for energy so you don’t need to snack. If you do snack, just recognize it as a bad habit. Eat only when you’re actually hungry. Don’t cave to a bad habit when you’re not actually hungry. Eat only, at most, three small meals a day. Even better: eat just two, or even one meal a day (OMAD). EAT ONLY WHEN YOU’RE HUNGRY. Your body will feed itself (on you) the rest of the time.

So, start with the pantry. It will be cathartic, and it will boost your confidence that you have finally crossed the Rubicon and there’s no going back. You can probably throw out almost everything. Think of all the space you will create! I started with the “vegetable” oils. They were all oxidized and rancid anyway. And the Crisco (trans fats).

If you have unopened jars of jelly or honey or boxes of sugar, donate them to a food bank. Virtue signaling will make you feel good.  Fill a garbage bag with open containers from the pantry and frig. That’s what all the sugar-filled, processed “foods” are anyway. Garbage. The exercise of clearing away the past and preparing to go forward into a future that you have envisioned for yourself is very Jungian. It’s the kind of self-therapy that supports the future you have chosen for yourself, a future in which you self-manage your type 2 diabetes by treating this disease for what it is: A DIETARY DISEASE. Repeat: TYPE 2 DIABETES IS A DIETARY DISEASE. And you can eat your way out of it, OMAD.

Retrospective #457: One foot in two lifeboats…

If you’re recently been diagnosed with type 2 diabetes (T2D), you may feel like you’re lost at sea with one foot in two lifeboats, each pointing in opposite directions. And it is now time to make a decision: Which lifeboat should you take?

One lifeboat is occupied by others like yourself and is led by the ship’s captain, who brought you to this point. The other lifeboat has survivors as well…and just a boatswain’s mate to guide you safely to shore. But you can only take one lifeboat! Will it be the captain’s lifeboat or the boatswain’s mate’s lifeboat? How do you decide?

The captain has a lot of education and experience. Wikipedia says, he’s “a commissioned officer and the ship’s master. He is “ultimately responsible for aspects of operation such as the safe navigation of the ship, its cleanliness and seaworthiness, safe handling of all cargo, management of all personnel, inventory of ship's cash and stores, and maintaining the ship's certificates….” We have confidence in our captain, right?

A boatswain’s mate has the rate of petty officer and also has acquired lots of knowledge and experience, but of a more practical nature. Wiki says, “Boatswain’s mates take charge of working parties; perform seamanship tasks; act as petty officer-in-charge of picket boats, self-propelled barges, tugs, and other yard and district craft.” In other words, a boatswain’s mate has the experience and navigational skill to coxswain a lifeboat.

Which “lifeboat” should you take? Well, the “ship” that brought you here…has sunk. The Captain failed you. And everyone else too who followed the McGovern Committee’s Dietary Goals for Americans, published in 1977, and the first Dietary Guidelines for Americans in 1980. The “Titanic” first set sail in the 50’s with physiologist Ancel Keys as Captain. His infamous “Seven Country Study,” got him on the AHA board and on Time Magazine’s cover in 1961.

You could get into that “captain’s” lifeboat. The current captain, your doctor, will use all the skills he learned in medical school (in a 1-hour lecture) to diagnose and treat your symptom, an elevated blood glucose. He will counsel you to lose weight; he will suggest “diet and exercise” and eat the “healthy fats” he and the USDA recommend (PUFA’s aka “vegetable” oils) And he will tell you to do what you have always done on this ill-fated “cruise,” just “eat less (on a cruise!) and move more.” And if that doesn’t work, (s)he will start writing prescriptions TO TREAT YOUR SYMPTOM.

This “boatswain’s mate” will steer you in a completely different direction – one that treats not a SYMPTOM (high blood glucose) but the CAUSE of type 2 diabetes, a dysfunctional metabolism. Instead of encouraging you to eat a “balanced,” “mostly plant-based” diet, high in refined carbs, sugars and “vegetable” (seed) oils, you will be counseled to eat a low carb, moderate protein and high fat diet, including saturated fat (not PUFA’s), to guide you to shore.

But as you can see, I have a bias. I lived the “high life” on the Titanic for 63 years. But I am among the lucky survivors who chose the “boatswain’s lifeboat.” After I made my decision 18 years ago in 2002, I lost (at one point) 187 pounds and a wile back had an A1c of 5.0%. I started my journey to remission and reversal of T2D by strictly eating just 20g of carbs a day. Within a week(!) of starting in 2002, I got off almost all of the anti-diabetic medications I was on.

My “coxswain’s” mates were mostly on online forums; I owe so much to them for their support. Today there are lots of special online support groups. I think the best is DietDoctor.com (subscription: $9/mo.); they get more hits in 1 day than I’ve had on my blog in 10 years. My favorite books are "The Obesity Code," by Jason Fung, "The Art and Science of Low Carbohydrate Living," by Volek and Phinney, and "Blood Sugar 101," by Jenny Ruhl.

Of course, I’d like it if you decided to read my blog regularly too. I publish this Retrospective Series daily now. I have a great editor who helps me make it readable and keeps me honest. She’s so much more qualified than I am, and in so many areas of health and wellness. I am so lucky to have had her help for all these years. As you can see, we do this without advertising. We don’t want or need ad revenues so we don’t sell or promote anything except an idea.

After the disastrous voyage you’ve been on that has brought you to this point, we know that all YOU have to do now, to make it to shore safely, is to make a smart, informed decision and step into the right lifeboat.