Monday, May 4, 2020

Retrospective #443: The 1-percenters

Major “lifestyle changes” are difficult. People are generally unwilling to accept the radical changes that are necessary and usually rationalize it by saying something like “everyone is different.” That’s a convenient scapegoat.
A while back, on a link suggested by a member on a nutrition website, I watched a TED talk. The talk was said to “help you find your ideal diet,” a “personalized program just for you.” It turned out to just be a businessman’s pitch for his startup’s service to for an “individualized” diet for you, for a fee. It was a sham, intended to appeal to a nutritionally naïve audience. This, unfortunately, would be 99% of the public, but I expected better from this nutrition site.
The truth is we are all human and our biological processes for digesting and absorbing the basic components of food –protein, fat and carbohydrates – are virtually identical. The only difference is the degree that a bundle of glucogenic genes have, to a lesser or greater extent, been “modified,” over many years, by overindulging, unnaturally, in a diet composed of a very high percentage of processed carbs and simple sugars. That will vary from person to person.
These “over-indulgers” have developed a dysfunctional glucose metabolism. Once “modified,” these genes continue to express this Carbohydrate Intolerance on a continuum. It is a path which will lead most people, over a period of years, to develop Type 2 diabetes and, for most, to become overweight or obese. The condition is called Insulin Resistance.
Insulin Resistance is thus a genetic expression of a bundle of genes, in those genetically predisposed, such that the insulin receptors on cells that ordinarily open up to allow glucose energy to enter and nourish them, no longer function properly. When these insulin receptor cells “resist,” and the uptake of glucose is impaired, the pancreas secretes more insulin to help out. Type 2 diabetes is thus a disease of too much INSULIN in the blood stream. Characteristically, TYPE 2S HAVE CONTINUOUSLY ELEVATED BLOOD GLUCOSE AND ELEVATED BLOOD INSULIN.
The elevated blood glucose is what clinicians use to detect the presence of incipient pre-diabetes or frank Type 2 diabetes. Today the hemoglobin A1c (HbA1c) is the blood test used to make this diagnosis. Previously, an elevated fasting blood glucose (FBG) was used. The gold standard, however, still used by endocrinologists, is the Oral Glucose Tolerance Test (OGTT). It takes 2 hours and is more expensive, but nevertheless, still the best.
The elevated blood INSULIN is what causes obesity (in about 80% of Type 2s). While insulin is elevated in the blood stream, to avert hunger the body must rely on food BY MOUTH for energy. Most people eat carbs at every meal and often between meals. The net result is that they are always hungry. Then, when they eat more and more often, they get fat. And, with INSULIN RESISTANCE, you’re the INSULIN level in your blood stays high. It’s only when your BLOOD INSULIN level drops that the liver switches to breaking down body fat (the food you’ve previously eaten) for energy.
The 1-percenters – those I call the cognoscenti – know this. Now, you do too. But knowing it and doing something about it are very different. It is hard to change one’s lifestyle and in particular one’s eating habits, which are both cultural and very personal. Incipient pre-diabetes and frank Type 2 diabetes are symptomless conditions.  And it takes decades to kill us, most often indirectly by heart attack, stroke, or Alzheimer’s (aka type 3 diabetes) and many cancers. These days, with better care, blindness, amputation and end-stage kidney disease are less common morbidities.
So, what would motivate a person to make a “lifestyle change” this drastic? Well, how would you like to “kill two birds with one stone”? Lose lots of weight and reverse your slow but indubitable slide into full-blown Type 2 diabetes? You can do both, but you will either have to eat Very Low Carb most of the time, or fast for a day or two a week, or both.
Sounds tough? What if you could eat this way without hunger? That’s what happens when your blood insulin level drops. When your body switches to body fat for energy, it is being fed so you don’t have to eat to stave off hunger pangs. A few days after you make the switch, your metabolism just runs on high test as long as you have fat to burn.
That’s what I did. I started eating Very Low Carb in 2002 and lost 170 pounds. When I plateaued a few times and gained 45 back, I added fasting. I lost 60+ pounds. I maintain my weight loss by eating Very Low Carb and fasting.

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