Sunday, May 10, 2020

Retrospective #449: “I thought salads were good for you.”

Don’t get me wrong. Salads are okay, but maybe not for the reasons you thought. I recently began mentoring a newbie type 2 diabetic who was diagnosed a few months ago with an A1c 7.0%. When he wasn’t able to tolerate Metformin and then Januvia (a DPP-4 as monotherapy!), he was prescribed a long-acting insulin, glargine. Another physician had prescribed a SGLT2, but cancelled it when he saw a counter-indication. So, I started by asking him what he ate, and when he got to lunch, he said, “chicken tenders and a small salad.”
When I said that the chicken tenders were dredged in flour, then breaded and deep fried in oxidized seed oils high in Omega 6’s, the look on his face signaled that I thought there might be a problem. I then added that salads were virtually all carbohydrates. That’s when he said, “I thought salads were good for you.”
And herein lies the problem. When I said, “Think about it. Not including ethyl alcohol (spirits, like vodka and scotch), there are only three macronutrients.” “What’s a macronutrient?” he asked. Well, that’s the state of our nutrition education! I told him, “The three macronutrients are protein, fat and carbohydrate. Everything you eat is essentially a combination of one or more of them. A good way to think of it is, if it’s not protein or fat, it’s carbohydrate.
The only “foods” I can think of that are 100% fat are the manufactured, refined, “vegetable” or seed oils (PUFAs) that I try hard to avoid. Most animal foods are a combination of mostly protein and fat. Most plant-based foods are almost 100% carbohydrates. There are exceptions, of course: some carbs contain some protein and even fat.
The best example is a Haas avocado, a plant food (a fruit, actually) that is high in “good” fats and fiber (non-digestible carbs). The fats are distributed as monounsaturated 71%, polyunsaturated 13%, and saturated 16% (15% total fat), 9% carb (mostly fiber), 2% protein, 2% ash, and 72% water. Avocados are a very good plant-based food. So is extra virgin olive oil (EVOO), another so-called “monounsaturated” fat, extracted (simply pressed, not processed) from a fruit.
So,  a salad of just leafy greens is basically 100% carbohydrate, albeit low-carb; but if your “small salad” had avocados, or hard-boiled eggs, or shredded cheese, or real bacon, or all of the above, I would say it was a very good salad, because of the protein and fat. But watch out for the dressing. Unless it is just olive oil and vinegar or an EVOO dressing of your own making, it is made from one of those refined, heavily processed “vegetable” oils – which are all very bad for you. Store bought dressings often have sugar added as well. So, make your own vinaigrette or OO & V.
Returning to my mentee, I gave him three books to read while on vacation: “The Art and Science of Low Carbohydrate Living,” by Volek and Phinney, “The Obesity Code,” by Jason Fung, and “Diabetes 101,” by Jenny Ruhl. Since he apparently has a sensitivity to the oral anti-diabetic medications he had tried, and he really didn’t want to be an insulin-dependent type 2 for the rest of his life, I wanted him to understand the concepts and the science behind treating type 2 diabetes as a dietary disease. I knew that if he followed the precepts of low carbohydrate eating, he would quickly GET OFF INSULIN and REVERSE HIS DIABETES, permanently, so long as he continued to eat low carb.
He was motivated, and he seemed to me to be the ideal candidate for a “dietary solution.” We agreed we’d meet again when he returned from vacation to talk about when and what to eat and what not to eat.
This is my area of expertise. I was never on insulin, or any of the new injectables that are frequently prescribed before insulin, but (in 2002) I was simultaneously on three different classes of oral anti-diabetic medications and would soon, my doctor and I knew, be injecting insulin. My T2 diabetes had been progressing since 1986, when I was diagnosed, as mainstream and establishment medicine still says it will. Little did we (my doctor and I) know. There is another way.
 Interestingly, my student said his caregiver (a NP masquerading as an MD) and her colleague, in another town (an internist masquerading as an endocrinologist), hadn’t mentioned a low carb diet as a self-management treatment. The NP just wanted him to follow orders, take his insulin, and return in 2 weeks for more tests.

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