Saturday, March 23, 2024

Type 2 Nutrition #1000: Oprah Winfrey or Me?

 In 2010, when I started to write about nutrition – specifically, nutrition for type 2 diabetics – I had no idea that I would write 1,000 columns. After all, my message was really quite simple: 1) take charge of your own type 2 diabetes health, 2) eat very low carb and 3) lose weight without hunger…and your type 2 diabetes will take care of itself. Your diabetes will quickly go into remission, and you will become healthier and happier with all your outcomes. The scale and your lab tests will testify to your success.

And that all proved to be true.

But it was also true that this Very Low Carb thing was a new paradigm. As such, at the time, it was not sanctioned by the medical establishment. In fact, it went against the Standard of Care. Clinicians were taught to treat a somewhat higher than normal blood sugar as a precursor to a metabolic disease condition which they named Pre-diabetes, to get a billing code. Then they established a new standard for defining full-blown type 2 diabetes (a different billing code), and just to be sure they were covered, they established that “obesity” was classified as a disease so it too could get its own billing code.

To treat these conditions, observable on any office scale and by simple laboratory tests, they could prescribe existing and newly developing pharmaceuticals to “treat” these symptoms of disease. And as the conditions worsened (because they had designated type 2 diabetes as a “progressive” disease), they prescribed higher doses and, with the passage of time, new classes of meds to treat the disease.

Of course, these physicians also advised patients to “diet and exercise” (“eat less and move more”), but when that didn’t work and the disease “progressed”, they blamed the patient for not sticking to the prescribed diet. On the patient’s chart it said “patient non-compliant.” It never occurred to the physician that it was the “prescription,” the diet recommended by USDA/HHS, Big Pharma, and the AMA, AHA, ADA, etc. that was the underlying problem…in point of fact, the cause of these chronic diseases.

So, in 2010, my storm-tossed message was lost in this sea of conflicting messages. I had to repeat it over and over, as it turned out, 1,000 times. But I did get some encouragement. Among the first, the 2015 Dietary Guidelines for Americans (DGA) stopped recommending that we eat no more than 300 grams of cholesterol a day. “Dietary cholesterol” was, “no longer considered a nutrient of concern.”

Another, the 2020 DGA declared that dietary fat be no longer limited to 30% of daily input. That was a tacit admission that eating fat didn’t make you fat. And, with protein at 10-15%, and carbs already at 55-60% (and by implication the leading cause of obesity and Insulin Resistance, this delimiting of fat allowed for fewer carbs. Unfortunately, they then doubled down by pushing for more “factory-made” fat (vegetable and seed oils), aka PUFA’s, instead of Saturated Fat naturally present is animal protein

Finally, the ADA, after years of opposing low carbohydrate diets as dangerous fads and hard to stick to, with “not enough long-term randomized controlled trials,” etc., the ADA relented and admitted that low carb diets were now an acceptable eating pattern for blood sugar regulation and weight loss.

But, in this storm-tossed sea, Big Pharma is fighting back. Recently, Oprah Winfrey had a primetime television network special touting the latest craze in weight loss drugs: a new class of injectable drug called a GLP-1. Two brands, Ozempic and Mounjaro, are among a passel in a crowded field that is very expensive ($1,000/mo.) and not covered by medical insurance (yet), and that’s why Oprah is schilling for them. She said, “don’t blame yourself” for being fat. She pointedly added, obesity is a “disease.” The 1-hour show was an infomercial for Big Pharma designed to get the taxpayer to “pay the piper.”

So, the way I see it is this: you have a choice: MY WAY: 1) take charge of your own health now, eat very low carb and lose lots of weight without hunger or 2) OPRAH’S WAY: wait for the lobbyists and politicians to make a deal, and then inject yourself in the belly with chemicals for the rest of your life.

Type 2 Nutrition #999: "Have I got a diet for YOU!"

 It’s been almost four years since I wrote my 997th and “final” column at My little writing adventure began in 2010 in response to a small, weekly-newspaper publisher’s request that I write (for free) a weekly 750-word column on any subject I chose. He needed content, and he knew (from many Letters to the Editor I had written) that I could write well enough to not require much editing and still not be a discredit to his newspaper.

The subject I chose was nutrition for type 2 diabetics. I had a story to tell, and he agreed. It all began in 2002 when my internist greeted me from his nurses’ station as I walked into the waiting room for a scheduled appointment. My doctor, an internist/cardiologist, said to me, “Have I got a diet for YOU!”

That was August, more than 21 years ago. Sixteen years earlier, in 1986, I had been diagnosed with type 2 diabetes. Over the years I had been prescribed oral anti-diabetic drugs until I was maxed out on one class and then another, and was starting a third. Soon, I would be injecting insulin or, in today’s drug world, a newer class of injectable. Because, that was (and still is) the Standard of Care for type 2s.

But my doctor wanted me to LOSE WEIGHT. He had me covered for diabetes (and hypertension) with drugs. However, a few weeks earlier, on July 7, 2002, he had read a New York Times Sunday Magazine cover story, “What If It’s All Been a Big Fat Lie,” by science writer Gary Taubes. The story attracted him because the cover photo was a ribeye steak with a pat of butter on top, and he was, besides my internist, a cardiologist. And, to a cardiologist, that picture was a prescription for a heart attack!

But my doctor tried the described diet himself, and in 6 weeks’ time, he’d lost 17 pounds. So, since he was starting a 2-week end-of-August vacation, he suggested I read up about it and start the diet the day after Labor Day, which I did. I had weighed in at 375 pounds that day, and I wanted to lose weight too.

The rest, as they say, is history. I lost 60 pounds in the next 9 months (39 weeks; 1½ pounds/week) but then regained 12 pounds over the next 4 years. So, I rededicated myself and lost 100 pounds in the next year, and then another 10 and finally another 30, altogether losing 188 pounds. By August 2017, I had become, quite literally (375/2 = 187.5), “just half the man I used to be,” to quote my wife.

I’m proud of the weight loss, of course, but importantly (and I almost forgot to mention it), from the beginning, my type 2 diabetes has been IN REMISSION (clinically neither “diabetic” nor “prediabetic”). My A1c is now 5.4%. Following the diet strictly, taking my prescribed meds, on the 1st day, I had a late afternoon “hypo” (a low blood sugar). I felt a little light headed, so I ate a candy bar and called my doctor who took me off one of the meds. The next afternoon I had another hypo, and he cut the other two meds in half, and soon after he cut them in half again. He then took me off the SU (micronase) completely and left me only on metformin, which I still take today. And I haven’t had a hypo since!

Importantly, my blood lipids also greatly improved: over a few months my HDL more than doubled, my triglycerides were cut by 2/3rds and my LDL stayed the same. My doctor saw me monthly for a year (quarterly now) and with all the weight loss, he was also able to cut back on my blood pressure meds.

And for the skeptics out there, here’s the big surprise: Today, MORE THAN 20 YEARS LATER, after making this lifestyle change in my Way of Eating, I am still more than 150 pounds lighter than when I started. At 222 pounds today, I’m at the weight I was when I started high school 70 years ago.

The diet? It goes by different names today, but there is only one governing principle: eat VERY LOW CARB. Just avoid them. All of them. There are NO essential carbs. The body can make all the glucose it needs from amino acids (from protein) and fatty acids (from triglycerides/fat) through gluconeogenesis. If a food is not fat or protein, it’s a carb. Period! If you’re overweight, or prediabetic, or a diagnosed type 2, you’re CARBOHYDRATE INTOLERANT. Avoid them.  To be healthy again, JUST DON’T EAT CARBS.

Type 2 Nutrition #998: "I write about nutrition." Crickets!

When I introduce myself as Dan Brown, people sometimes hesitate and then ask, “Are you…” I reply, “No, but I do write a little.” Then they usually ask, “About what?” and I say, “Nutrition.” Pause. Crickets.

No, I’m not talking about eating bugs. I’m a meat eater. Mostly protein and fat. As few carbs as possible. But the silence (“crickets”) is because… I am, well, still “overweight.” At 5’-10” (shrunken from 6 feet), I currently weigh 222 pounds. I’m not muscular, so all that extra weight is body fat. My BMI is 32 (obese). Overweight is 25 to <30. “Healthy” is 18.5 to <25. And frankly, I would call that BMI “sickly.”

“Crickets” is just being polite in casual conversation. The “silent person” is actually thinking, Would I take nutrition advice from a person who is obese? Especially if that “silent person” is “normal” weight. Out of context, the answer is, “no”! It’s ludicrous. I actually laugh when I see the morbidly obese Health Minister of a certain European country or even our own U. S. Assistant Secretary for Health.

But context is important. (Witness: “bloodbath.”) While my current BMI is 32, my BMI used to be 52. And, at 222 today (2024), I still weigh more than 150 pounds less than I weighed in 2002 (375). Without surgery! Or exercise! Just nutrition. Just learning about the physiology of weight gain and weight loss.

So, after I lost all that weight (and as adjunct put my type 2 diabetes “in remission” in the first days before any weight loss), I had the opportunity to write about nutrition for a local weekly newspaper, and I took it. And then I discovered the internet, and I started posting my columns on line. This is #998.

How did I do it? I already told you. It’s not complicated. I eat mostly protein and fat, and as few carbs as possible. I like all animal protein, and full-fat dairy, but I limit my daily dairy to heavy cream and butter.

For “meat,” I prefer ruminant species, principally beef (steaks or chopped/mince) but lamb is good for a treat. I sometimes eat pork and chicken (skin on), but never breaded or deep fried. All seafood appeals to me, but I’m partial to shrimp, clams, oysters and mussels, and cod or any other white, flaky fish. For lunch, I love a can (tin) of sardines, tuna, mackerel or salmon, so long as it’s packed in olive oil or water.

I skip breakfast, except for coffee, and as you can see, I eat a very light lunch (just a can/tin of fish). And supper is usually just one of the “meats” I’ve described above, with fat. I don’t prepare a vegetable, but I do eat vegetables when served in a restaurant or by a host. I prefer the above ground type or the leafy type. I don’t eat bread or potatoes or other root vegetable (except on Thanksgiving and Christmas day).

Why am I not hungry? Here’s the physiology part: There are only three macronutrients: protein, fat and carbohydrates. Protein has many important bodily functions, building and maintaining a host of essential structures and processes, but it is not a primary fuel. Fat is a dense fuel (9 kcal/g) used as a secondary fuel and stored long term for that purpose as body fat. Carbohydrates act as a less dense (4kcal/g) but easily available primary fuel for immediate use or short term (1-2 day) storage.

Carbs are almost all converted to glucose and enter the blood for circulation and “pick-up” by muscle and other cells. Glucose is accompanied by the transporter hormone INSULIN to “open the door” so it can get picked up. High levels of glucose in the blood are very bad, so insulin has to always do its job. And if we’re always eating carbs, blood insulin levels stay high, and the “cell door” becomes RESISTANT.

So, the “secret” to losing weight when you have INSULIN RESISTANCE is to eat as few carbs as possible. That way, the insulin level in the blood will drop (since the glucose level has dropped), and the body can turn to burning your backup body fat for energy. And if you’re still fat like me, you’re never hungry. ;-)

The body doesn’t need carbs for energy. It can make all the glucose it needs from protein and fat by a process called gluconeogenesis. And when body fat (triglycerides) breaks down for energy, besides making fatty acids for fuel, it also makes ketones for fuel, which both your brain and your heart love!