In Retrospective #449 I described how I met and began to mentor a newly diagnosed type 2 (A1c 7.0%) who was prescribed a long-acting basal insulin after he was unable to tolerate or had a counter-indication for three classes of oral anti-diabetic meds. My student was motivated because he didn’t want to be a life-long, insulin-dependent type 2. I thought he was the ideal candidate for a “dietary solution.” I knew that if he followed the precepts of Very Low Carb eating, he would quickly reverse his diabetes and get off insulin.
His healthcare provider’s goal was to mediate or offset his high blood sugar (a symptom of Insulin Resistance from eating a diet high in sugars and other highly refined carbs) by administering exogenous insulin injections. My goal was to get him off injected insulin by lowering his blood sugar and endogenous (pancreatic) insulin response through diet. Eating Very Low Carb will lower his blood glucose and therefore his endogenous insulin response. Thus, this lower blood insulin will reduce and quickly eliminate the need to inject exogenous insulin, and help him lose weight.
Aside: I counseled my student to be prepared to learn and to test his blood regularly and whenever he had symptoms of a “hypo.” “What’s a hypo,” he asked? Incredulously, his “doctor,” the NP – the one who “prescribed” insulin injections for him – “forgot” to mention hypoglycemia. Neither did they discuss an A1c goal, but the American Diabetes Association’s Standard of Care is ≤ 7.0%. His typical fasting blood glucose (with a starting dose of 10 units of basal insulin) is still 170mg/dl, so he’s expecting she will soon have to raise his dose of injected insulin.
Insulin, endogenous or exogenous, causes weight gain. When your blood insulin level is elevated, your body cannot access body fat for fuel. Once off exogenous insulin, a LCHF diet will enable him to lose body fat, if he wants or needs to, without hunger. Principally, by burning visceral fat in the peritoneal cavity around and within the liver and pancreas), he will ultimately restore beta cell function and his body’s endogenous insulin production.
WHEN AND WHAT TO EAT, AND NOT EAT
If you eat a Very Low Carb, High or Healthy Fat diet, sometimes referred to as a LCHF or Keto diet, you will not feel hungry very often because your body is being fed by its own body fat. It won’t signal you to eat food by mouth as long as, when you do eat, you eat Very Low Carb. If you have a lot of body fat to lose (he doesn’t), then you don’t have to eat a lot of fat. Your body will “eat itself” (your stored fat). Without a lot of body fat to lose, he can eat more fat (saturated and monounsaturated) than others who have a little or a lot to lose. So, my advice when you eat Very Low Carb is, eat only when you’re hungry. After a while, when you always eat this way, your body will be “fat-adapted.”
What does this mean in terms of meals and timing? Mealtimes are cultural and social habits. My student likes to eat a small breakfast: one egg and some Canadian bacon. That’s good. He doesn’t drink coffee. For many years I ate eggs and bacon for breakfast. Now, since I’m not hungry at breakfast, I just have a cup of coffee. It’s a habit. I take it with a little pure powdered stevia and a dollop of heavy whipping cream.
If you’ve got nothing better to do at “lunchtime,” and you’re hungry, eat a small lunch. When I eat the occasional lunch, I prefer something portion controlled. It’s usually a can of some kind of fish. I like kippered herring in brine or Brisling sardines in EVOO or water (not packed in refined “vegetable” i.e. seed oils). Salmon, smoked or canned, would be really good too. Some days I’ll have a hardboiled egg, or two. Low-fat cottage cheese and any yogurt are not good choices, because lactate is milk sugar. But if you do, eat full-fat without syrupy fruit. In fact, avoid fruit altogether.Supper is just a fatty protein like beef, veal, lamb, fish, pork or chicken (skin on), and one low carb vegetable tossed in real butter or roasted in olive oil. Of course, no bread, potatoes, pasta, rice, wheat flour, or root vegetables. I also avoid corn, peas, carrots and beets because they’re high in natural sugar. And no candy, dessert or snacks. Trust me. If you can control your neurotic cravings between meals or after supper (it’s not hunger; you won’t be hungry), you’ll be just fine. I knew that by eating Very Low Carb, my student would quickly reverse his diabetes and get off insulin.