Retrospective #44: Joslin Clinic Fights Back (The Blind Leading the Blind)

The Joslin Diabetes Center in Boston is “the world’s largest diabetes research center, diabetes clinic, and provider of diabetes education,” according to Wikipedia. It came as no surprise, therefore, when on February 8, 2012 Joslin shot back at comments made by Richard Kahn, Ph.D., former Chief Scientific and Medical Officer of the American Diabetes Association. The comments were made at a briefing for public health advocates and diabetes researchers regarding his February 7, 2012 article, “Confronting the Growing Diabetes Crisis,” in the journal Health Affairs.

Dr. Kahn controversial statement was, “Even though weight loss can prevent or delay the onset of diabetes, the failure of patients to maintain weight loss beyond an average of four years makes diabetes prevention programs ‘a waste of resources,’ The health system should focus instead on reducing the likelihood of complications once patients have been diagnosed with diabetes.” (Emphasis added by me.)

Joslin’s rebuttal was given by Edward S. Horton, MD, Professor of Medicine at Harvard Medical School (with which Joslin is affiliated), and past President of the American Diabetes Association. He said that Joslin had extensive “experience with innovative weight management programs [that showed] that patients can maintain healthy weight levels well past four years.” “There is a legacy,” he added, “for the initial weight loss even if people cannot maintain it. The 10-year follow up of the patients who completed the diabetes prevention program showed that people who initially lost weight continued to develop diabetes at a lower rate over 10 years than those who did not lose weight, even if they gained part of that weight back.”

This internecine battle of former ADA officers demonstrates clearly that overweight and obesity is a big problem, as well as the surest predictor of incipient Type 2 diabetes. Further, it clearly identifies losing weight as the first line of defense against “developing diabetes at a lower rate” and “the likelihood of complications.”

Type 2 diabetes is also associated with a multiple Diseases of Civilization (CVD, CHD, stroke, Alzheimer’s and some cancers).  A recent NY Times story reported, “Researchers found diabetes was associated with a higher overall risk for colon, rectal and liver cancers among both men and women. In women, diabetes was most strongly associated with a higher risk of stomach, anal and endometrial cancers. In men, diabetes was most likely to raise risk for pancreatic and bladder cancers. So, there’s wide recognition for the benefits of “developing diabetes at a lower rate” and avoiding “the likelihood of complications.”

The battle also illustrates the difficulty of losing weight and keeping it off. Even Harvard Medical School’s defenders of Joslin’s programs, in remarks posted in Public Health and Policy (issue 612) one day after Dr. Kahn’s controversial statement, appear to disagree. Enrique Caballero, M. D., said, “Not having a full answer on what to do in the long term does not mean that efforts to identify these strategies and translate them to clinical practice model should be abandoned.”

On the other hand, Martin Abrahamson, M. D., Chief Medical Officer at Joslin Diabetes Center and an Associate Professor of Medicine at Harvard Medical School, said, “Since we know which weight management programs will work in the fight against obesity, the challenge is to find ways to implement them in communities, which we at Joslin are working hard to do” (emphasis added in both quotes).

The problem is that Joslin’s “innovative” weight management programs are not innovative. Joslin and Harvard still cling to the Diet-Heart or Lipid Hypothesis promulgated by Ancel Keys in the early 1960’s and later the American Heart Association: Saturated fat and dietary cholesterol are bad for you. Although increasingly recognized as unproven, this hypothesis still dominates in the medical establishment and suffuses public health policy.

Until this “corrupt bargain” is broken, our health will continue to decline as rates of obesity, Type 2 diabetes and “the likelihood of complications” all rise. The Low-Carb, High-Fat Way of Eating advocated here is a solution. Be aware, though, that it is an heretical guide to easy weight loss (without hunger), remission of Type 2 diabetes, and avoidance of the dreaded complications. Your doctor will really like the results of all your blood tests too.

Retrospective #42: “Unsafe Fats”

While surfing the net one day in 2012, an ad for “Beyond Diet” had a clickbait banner that read, “5 Foods to NEVER Eat.” It worked. I clicked to see if they were dead wrong. They were not! To my surprise, they had it right; they were selling the same message that I espouse at thenutritiondebate.com: Avoid sugar in all forms and all processed and refined “foods” that are sold in boxes and bags; and avoid gluten grains and polyunsaturated fats (PUFAs), the seed oils that are easily oxidized and damaged, especially when used over and over in deep fat fryers. All the PUFAs, aka “vegetable” oils, are “unsafe”: corn oil, soybean oil, sunflower, safflower, peanut and Canola oil.

Instead, eat “real food,” whole foods, including meat and eggs, animal products which contain fats naturally found in nature. “Beyond Diet” did have the “right” message. It was refreshing news in the 2012 wilderness that I recall.

The most universally considered “safe” fat is olive oil, a monounsaturated fat. Another mostly monounsaturated fat is avocado oil, which I now use to make my own mayonnaise. Store bought mayo is made with soybean oil, and most brands have added sugar. Beware of the use of the words “made with olive oil” on a mayo label. Olive oil is just a minor ingredient, and the product is so adulterated it can’t even be called “mayonnaise.” It’s a “spread.”

 The avocado fruit, which I occasionally have for lunch, is high in monounsaturated fats. I eat it with my homemade vinaigrette dressing in the pit cavity and real crumbled bacon pieces (Hormel) added on top for a little protein.

Most animal products are combinations of protein and fat. Some are surprisingly high in monounsaturated fats (pork e.g. 44%). The saturated fat gives it the flavor we like. I prefer fatty meats, poultry and fish, especially the fatty cuts: bone-in cuts, mutton and lamb chops, and baby-back ribs rubbed and roasted. I also eat salmon and tuna and dark meat chicken - skin on. Did you know that chicken skin is mostly unsaturated fat?

I learned this from the doyenne of lipid biochemistry (dietary fats), Mary Enig, PhD (now deceased).  Beginning in 1978, after reading the 1977 McGovern Commission report, she fought tirelessly to have trans fats acknowledged as unhealthy. I credit her with the victory in the FDA’s 2003 edict requiring trans fats to be listed separately on the Nutrition Facts Panel on processed foods. It’s working. Blood levels of trans fats declined 58% between 2000 and 2009, according to a CDC research letter published in JAMA and reported in the February 8, 2012, New York Times.

You can read Dr. Enig’s story in “The Oiling of America.” Other good reads with co-author Sally Fallon, President and Founder of the Weston A. Price Foundation (WAPF), are “The Skinny on Fats” and “The Truth About Saturated Fats.” In addition, WAPF has published, “Nourishing Traditions: The Cookbook that Challenges Politically Correct Nutrition and the Diet Dictocrats.” These resources explain why polyunsaturated fats (vegetable oils) are unsafe.

The Weston A. Price Foundation website itself is a major resource declaiming “industrial foods” and advocating for nutrient dense whole foods. These foods contain the critical fat-soluble vitamins A, D and K2 which are found exclusively in animal fats of grass-fed animals, organ meats and seafood. Foods such as butter, egg yolks, whole raw milk, full fat cheese and liver are the basis of good health, WAPF says. WAPF membership, which includes a quarterly newsletter and an annual buyer’s guide, is only $40 ($25 for seniors). I highly recommend it.

Whatever happened to beef tallow and lard? Butter is one of the very best foods, yet we forsook it for trans-fat laden margarine. Whole eggs are a nearly perfect food, yet, when we have eggs, we use Egg Beaters or All Whites.

Enough kvetching. Earlier in this Retrospective series, I posted a 4-part series on dietary fats: #20: “Know Your Dietary Fats,” #21: “The Dangers of Polyunsaturated Fats,” #22: “Omega 6s and Omega 3s,” and #23: “The benefits of Saturated Fats.”  Scroll down (on the website) to see them. On Facebook, click on my name to get to my “homepage” and search there.

I checked the Beyond Diet website again today (March 2019), and they’re still there, claiming over a million subscribers. They’re selling a service, of course, but they’ve got the right message. I’m glad they’ve succeeded.

Retrospective #41: Sugars and “Unsafe Starches”

At dinner last night with my brother in Florida, he told me that a doctor friend had recently told him, “A glass of orange juice was one of the worst things” he could eat or drink. I agreed. I told this to my wife this morning as she was drinking hers. She just continued gulping it down. Neither my brother nor my wife is a Type 2 or Pre-diabetic.

You can buy “fresh-squeezed” orange juice in Florida by the gallon. It’s as cheap as day-old bread, and it’s really delicious; but it’s all sugar (with a little fiber) and more than half fructose. Liquid sugar is a heavy load for the liver. So is a HFCS coke. There’s no difference really. Most conventional Registered Dieticians would tell you this.

Sugars are carbohydrates composed of either one or two molecules (monosaccharides and disaccharides). The monosaccharides are glucose, fructose and galactose, the most common of which is glucose, sometimes called dextrose. The most common disaccharide is sucrose, usually refined either from cane sugar or sugar beets.

Table sugar is sucrose. Sucrose is half glucose and half fructose. Simple sugars are unsafe because they are broken down and digested quickly, especially when liquid. The glucose goes into the bloodstream from the small intestine and circulates to the cells for energy. The fructose, a mild toxin in large doses (look up “hormesis”), is diverted to the liver to be “detoxified,” protecting us from it. There, in a liver already overloaded with glycose (stored as glycogen), it becomes body fat via de novo lipogenesis, and in some cases liver fat. See fatty liver disease or NAFLD.

“Unsafe starches” are complex carbohydrates (polysaccharides and therefore also ‘sugars’ that break down to mostly glucose in the blood) in non-whole food form. They are manufactured “foods” that have been processed and refined in manufacturing, thereby making them break down to simple glucose molecules much more easily. That’s why they are unsafe: They act like simple sugars, digesting quickly and easily, thus spiking blood sugar.

The sugar in milk is lactose, a disaccharide composed of equal parts glucose and galactose. Milk has a lot of lactose. The processing also removes vitamins, minerals and phytonutrients. The vitamins that are in whole raw milk are killed in the pasteurization/ homogenization process. That’s why homogenized milk is supplemented with Vitamin D. Low fat and skim milk also have more carbs (in proportion) than whole milk, since the fat has been reduced or eliminated. That’s why I don’t drink, skim, low-fat or even whole-fat milk. I only take full cream in my coffee.

White flour (bleached or unbleached), is refined from wheat, a gluten grain. The milling process removes nutrients so bread flour is almost always “enriched” to replace lost nutrients, e.g. Iron, Niacin, vitamins B1 & B2, and Folic Acid. At random I recently checked the ingredients list on three loaves of bread. Arnold Whole Grains 12 Grain Bread’s first three are Unbleached Enriched Wheat Flour, Water and Sugar, plus about 50 other ingredients. Pepperidge Farm’s Whole Grain Bread’s first three ingredients are Whole Grain Wheat Flour, Water, and Sugar. Publix’s supermarket store brand, their “Large White” bread, lists, again in order, Unbleached Enriched Wheat Flour, Water and High Fructose Corn Syrup (HFCS), among many other ingredients including soybean oil.

Did you have any idea that sugar was the third ingredient listed in “healthy” breads, after flour and water? Added sugars are in virtually all processed foods. These breads and virtually all others are unsafe starches. Note also that wheat gluten, a protein, is listed fourth or fifth. Gluten is one of the three Neolithic Agents of Disease (NAD’s) in Dr. Kurt Harris’s Archevore program, along with fructose and polyunsaturated fatty acids (PUFA’s), i.e. vegetable oils.

It makes you pine for a good ole “loaded baked potato,” doesn’t it? For the uninitiated, a loaded baked potato is a large steaming baked potato that is “butterflied” and filled with butter, sour cream, broccoli, melted cheese and bits of bacon. Sounds good, doesn’t it? A whole “safe starch” food (scroll down to Retrospective #40 below), a green veggie, and lots of good saturated fats (butter, sour cream, bacon and cheese). Of course, being a Type 2 diabetic, no starchy food is “safe” for me. I have a seriously impaired glucose metabolism. I am carbohydrate intolerant, but that’s okay. I’ll have a can of King Oscar brand Brisling sardines, in olive oil, for lunch every day.

Retrospective #39: Fad Diet or Diet Trend?

Edgy diet plans are often described as fads, and they usually are. The Stillman Diet, 50 years ago, was high protein, 8 glasses of water, and amphetamines (!), as I recall. I was on it, and I lost 65 pounds. After a while, fortunately, I tired of it and switched to ‘the grapefruit diet.’ That too was a fad diet, and today there are many such examples that do not deserve consideration or even mention here.

Recent diet trends are a lot healthier. They are rooted in “real food.” This began, I think, with the concept of organic foods. This trend evolved to include another dimension besides health: to try to do the “right thing,” take the high road, adopt a moral and ethical way of eating and living. To illustrate, responding on the Oprah program to a question about eliminating meat from the diet, Michael Pollan said, “That’s a personal choice. I could eat meat in …(a) very limited way, from farmers who were growing it in a way [grass fed and finished] that I could feel good about how the animal lived – and that we’re not taking that grain [corn] away from people who need that food.”

Michael Pollan publicized the grass-fed movement in his best-selling, compelling book, “The Omnivore’s Dilemma.”  It was followed by other derivative books by him and others urging that we eat “real food.” This was a back-to-the-future moment for me. It advocates that we eat only the “real food” that is found on the perimeter in the side or rear of the modern supermarket. The idea is to avoid processed and manufactured food sold in boxes and bags.

“Grass fed” is different from “grass fed – grass finished”. The latter means 100% grass fed. Grain fed for just a few weeks in the “finishing” period will change the critical Omega 6/Omega 3 ratio. Thus, “the devil is in the details.”  The best practice is to ask the grower, and that means buying meat from the grower. And grass finished is difficult in winter in northern climes, a New York grower told me. See eatwild.com for a list of grass-fed/finished producers.

Eggs are another matter. Eggs are inexpensive and a complete source of protein and fat. I eat a lot of eggs, but I see them often advertised as laid by hens fed a vegetarian diet. Chickens are omnivores, so I want hens that eat insects naturally, in a pastured setting. “Free range” and “cage free” don’t do it for me. That means they spend their entire lives confined under a roof, eating a mostly corn meal diet, with soy. A hen that eats such a vegetarian diet is going to produce eggs that have too many Omega 6’s and not enough Omega 3’s. “Pastured eggs” are worth it to me.

I buy eggs at farmers’ markets where I know the purveyors. I’ve been to their farms, and I know their hens are pastured. That means they are moved weekly from pasture to pasture (with their portable coop) to places where cows, sheep or pigs have recently grazed. And I also know the eggs I buy are fresh (AA) – only a few days old.

The latest, big trend in dieting (in 2012) is Paleo, based on anthropologic and ethnographic antecedents. One of my favorite blogs, since lost to the ether, was Archevore, by Kurt Harris, MD. His basic premise: avoid the Neolithic Agents of Disease (NAD). NAD is his phrase to describe changes in the human diet that were introduced with the advent of the Neolithic Age 10,000 years ago. They are 1) wheat (and the closely related gluten grains barley and rye); 2) excess amounts of fructose; and 3) polyunsaturated fatty acids (PUFA’s) from processed vegetable oils.

The Paleo trend has generated considerable discussion online. Controversy centering on “safe starches” emerged at the 1^st Ancestral Health Symposium in Los Angeles. This was a debate between the ‘establishment’ low-carb community, many of whom are Type 2 diabetics or Pre-diabetics, and the emergent Paleo crowd that tended to be younger, healthier and interested in a program that may prevent and even heal “middle age and chronic health problems through diet.”

In 2012 Paleo was newly popular as a modern diet trend and was still evolving (pardon the pun). It also had a broader potential application, as it is not intended solely for those who have a diagnosed metabolic disorder (e.g. Type 2 diabetes), or Insulin Resistance or symptoms of Metabolic Syndrome, evidenced by obesity. In that sense, it was a debate between the Prophylactic and the Therapeutic dieters: how to stay healthy vs. how to regain your health. For more on that, scroll down for Retrospectives #36 and #37. For “safe starches,” see the next post.

Retrospective #38: The Perfect Health Diet

“The Perfect Health Diet is more than just a diet – it is a program for perfect health, “say Paul Jaminet, Ph.D., and Shou-Ching Shih Jaminet, Ph.D., who together developed it. “A diet like the Perfect Health Diet should be the first treatment option in most diseases and an adjunct to therapy in all,” they say at perfecthealthdiet.com. Perfect!

The Perfect Health Diet was developed by “two scientists with a longstanding interest in diet and health. We have been experimenting with low-carb diets since 2005,” they say, and “have successfully healed our own ‘middle-age’ and chronic health problems through diet.” Their plan has adherents eating about two-thirds plant foods and one-third animal-based foods by weight. Besides a high fat content, the diet is further characterized by complete avoidance of sugar and cereal grains. On their website they say, “Do not eat toxic foods, notably:

·         Do not eat cereal grains – wheat, barley, oats, and corn – and foods that contain them – bread, pasta, breakfast cereals, and oatmeal. The exception is white rice, which we count among our ‘safe starches.’ Rice noodles, rice crackers, and the like are fine.

·         Do not eat calorie-rich legumes. Peas and green beans are fine. Soy and peanuts should be absolutely excluded.

·         Do not eat food with added sugar or high-fructose corn syrup. Do not drink anything that contains sugar. Healthy drinks are water, tea and coffee.

·         Polyunsaturated fats should be a small fraction of the diet (~4% of total calories). To achieve this, do not eat seed oils such as soybean oil, corn oil, safflower oil, sunflower oil, canola oil, or the like. The best cooking oils are coconut oil, clarified butter, and beef tallow; palm oil, lard, olive oil and avocado oil are next best.

“Eat nourishing foods: liver, egg yolks, seaweeds, and shellfish, vegetable and bone broths. Make sauces from an acid (lemon juice, vinegar), an oil, and herbs. Get sufficient salt.

“Take care to obtain adequate amounts of eight critical micronutrients: vitamin D, vitamin K2, iodine, selenium, magnesium, copper, chromium and vitamin C. Many of these can be obtained from sunlight (vitamin D) or what we call ‘supplemental foods:’ seaweed for iodine, Brazil nuts for selenium, beef liver for copper. Others may need to be supplemented.”  They don’t recommend fish oil supplements, but they do like oily fish like salmon and sardines.

The authors of the Perfect Health Diet (the “PHD” Diet, as they’re both PhD.’s, get it?) consider their program low-carb. With 400-600 calories (100-150 grams) from carbohydrates (mostly “safe starches” like rice, potatoes, sweet potatoes, taro), plus fruit and berries, it is lower than the Standard American Diet (SAD) which recommends 1200 calories (300g) a day from carbs for women and 1500 calories (375g) for men. They suggest that if your metabolism is compromised (for example, by obesity or other manifestations associated with Metabolic Syndrome), you should lower the carbs further to 200 carb calories (50 grams), a level of carbs they call “a therapeutic ketogenic diet.”

Protein should be, they say, “a modest fraction of daily calories,” which they define at 200-400 calories (50-100g). “Fats should supply most (50-70%) daily calories,” they conclude. Taking the middle value for all three macros, that’s 500 carb calories (125g), 300 protein calories (75g), and 1200 fat calories (133g) = 2000 calories total.

Their “therapeutic ketogenic diet,” for Type 2s and Pre-diabetics, would reduce carbs to 50g. (200 calories), the same 75g protein and 133g fat = 1700 calories total, and “perfect” for both weight loss and therapeutic features.

In many ways the Perfect Health Diet is similar to the Archivore program developed by Kurt Harris, M. D., discussed in Retrospectives #18 and 19 in this series. The principles are similar, but Harris says his program is more rooted in ethnography and anthropology. The Jaminets point to evolutionary indicators of the optimal diet for perfect health (e.g., breast milk for infants) and mammalian diets in general. Both agree, the Jaminets conclude, “Fortunately, all of these sources of insight seem to be consistent in supporting low-carb, animal-food-rich diets – a result which is gratifying and should give us confidence.” I couldn’t agree more. They are two of my favorite “low-carb” diets.

But my absolute favorite thing about the PHD Diet is the graphical symbol (a pictogram) for the program that they created to depict the foods they suggest we eat and not eat. Check it out at perfecthealthdiet.com/the-diet/.

Retrospective #37: Therapeutic vs. Prophylactic Dieting

A prophylactic diet is designed to lose weight and to prevent the health consequences of weight gain: the advent of disease. A therapeutic diet is designed to lose weight and to address the consequences of the onset of disease. This list of therapeutic diets illustrates how a diet can be designed both to lose weight and to improve your health.

The Therapeutic Ketogenic Diet, and “Keto” Diets

The Therapeutic Ketogenic Diet was developed at Johns Hopkins University in the early 1920’s to treat epilepsy in children. It is an effective medical therapy, but its popularity waned with the development of drugs. The diet is 90% fat by calories. Modern hacks of this diet, popular for weight loss, are called simply “Keto” diets. They are are 65 to 70% fat, both body and dietary fat, since your body fat is consumed for energy when you eat Very Low Carb.

The Atkins Induction Diet

Atkins Induction is considered to be low carb (which it is), and high protein (which it isn’t!), because nobody will call it high fat. It is high fat. Atkins Induction (Phase I: 20g Carbs/day) is a version of the ketogenic diet at 55 to 65% fat. It is a weight loss diet especially effective for people with medical conditions such as cholesterol issues (low HDL and high triglycerides), high blood pressure, and Type 2 diabetes. It is also an effective regimen for those with Metabolic Syndrome. See Retrospective #9 “Metabolic Syndrome,” to review the symptoms and evaluate yourself.

The Bernstein Diet

Richard K. Bernstein, MD, has been a Type 1 diabetic for about 70 years. He developed a very low carb, moderate protein, high fat diet, 30 grams of carbs a day, 6-12-12, for breakfast, lunch and dinner. This Way of Eating (WOE) emphasizes “eating to the meter” in order to control post-prandial (after meal) blood glucose levels.  The Bernstein program is a very effective way for Type 2s to lose weight, without hunger or lethargy. Your lab results (blood sugar, blood lipids and, as you lose weight, blood pressure, will improve as well, but it requires major dietary changes and strict compliance. It’s challenging, unless you realize your improved health, your lifespan really, depend on it. Many Type 2’s, and those who want to avoid becoming Type 2, eat just 30g of carbs a day. By “eating to the meter” you will maintain a stable blood glucose and completely avoid a progressive worsening of disease.

The Diet Doctor’s LCHF Diet

This diet is described in Retrospective #35 below. Eating Low-Carb, High-Fat (LCHF) is a great way to lose body fat. It provides satiety, or a sense of fullness, that permits you to eat two or three small meals a day with no snacks. It maximizes body fat burning and thus keeps a high metabolic rate. It is thus similar to the 3 diets described above.

These diets are all safe and effective therapeutic diets. They are mostly designed for Type 2 diabetics (like me), or Pre-diabetics, or people who are overweight with symptoms of Metabolic Syndrome (Scroll down to #9). They all require a lifestyle change and a lot of self control, but they are life changing in their benefits. You will achieve dramatic weight loss without hunger and without loss of energy. Most important, you will achieve dramatic improvements in health by all clinical measurements (blood lipids, i.e. cholesterol, blood glucose, blood pressure and inflammation). But because they require strict compliance, most people won’t even give them a brief trial.

Besides, unless your doctor tells you that you are sick, you may not think there is a reason to change your lifestyle. Just “Take this pill and you’ll be healthy,” (s)he says (and you hope), so you won’t think major changes are needed.

Consider taking responsibility for your own health. After all, most people still have not been diagnosed with a chronic disease, yet, but they often have unrecognized symptoms, especially high post-prandial blood glucose. And if they do have symptoms of Metabolic Syndrome, when a doctor recognizes them, he or she will write a script for a pill: a statin, or a blood pressure pill, or Metformin. Sure, for the “healthy” population out there (and most of you think that includes you, right?), the easy thing to do is kick the can down the road for a few more years. A few more pounds, a few more pills. A prophylactic diet today, a therapeutic diet tomorrow. It’s your choice, of course.

Type 2 Nutrition #478: Why I still use stevia.

While the debate raged about artificial sweeteners, I always took comfort from the knowledge that the sweetener I used, in coffee and iced tea, was not artificial; it was a pure natural extract from the leaf of a South American plant, Stevia rebaudiana. I'm not talking about a combination product like Truvia, packaged with a sugar alcohol, or Stevia in the Raw, combined with dextrose or maltodextrin (both 100% glucose chains) as "bulking agents." I am talking about 100% refined stevia leaf extract, either in powder or liquid form.

I use stevia powder in my coffee in the morning. I started out with a 16oz cup, with 12oz of coffee, about 2oz of heavy whipping cream (HWC) and a rounded 1g measure of stevia powder. When I decided that was too much fat from the cream, I downsized to a 12oz cup with about 1 1/2oz of HWC and a level 1g measure of stevia. When I discovered that I needed less than a cup to take my pills, I started experimenting with half a cup of coffee (and less HWC and stevia). That worked too, but I like my cup of coffee in the morning...

I also use stevia in liquid form in the cold-brew Lipton iced tea I make in half-gallon glass bottles for my go-to beverage during the day. It's quite refreshing when it's been chilled overnight in the refrigerator. I have 2 bottles and rotate them so one is always cold. After the tea "brews," I squirt in a couple eye droppers of liquid stevia and mix. I drink at least a half-gallon a day year-round -- more in summer -- to remain hydrated.

Because I generally eat Very Low Carb (LCHF) or "Keto," I am usually "keto-adapted." When the food I eat has been digested and absorbed, my body transitions without hunger from a fed to a fasted state. My metabolism changes from relying on the food I ate to the food it has stored on my body without slowing down. That's the theory of being "keto-adapted." And since I lose weight easily without hunger and with lots of energy when I follow this Way of Eating, I haven't felt the need to change my "stevia habit."

But there is this nagging thought:

Doesn’t the stevia I take in my morning coffee raise my blood insulin? It surely must, to some extent. It is sweet! And although I probably lost my " first-phase insulin release" decades ago, nevertheless, the Cephalic Phase of digestion is still there, isn't it? Or, is the secretory response of insulin inhibited by not being hungry?

Likewise, if every glass of my sweetened iced tea is laced with stevia, won't it also put the brakes on my keto-adapted metabolism? Again, it doesn't seem to. Perhaps my description of my metabolic state as being “keto-adapted” -- which is entirely subjective; I do not have a keto meter or use keto test strips to test my urine-- is untrue. Perhaps I am not in a state of “nutritional ketosis” after all. Maybe I am just able to use body fat for fuel because I eat Very Low Carb, and therefore always have a low serum insulin, and therefore can always burn either the food I eat (almost all protein and fat) or the food stored around my waist (all fat).

But, again, if my body senses the "sweet" tea and coffee, won't that stop the breakdown of my body fat for fuel? And if that happens, and I have offered the body no carbs for a quick energy pick-me-up -- and only tricked it into thinking it would receive some glucose energy by the "sweet" signaling -- won't that slow my metabolism? It's supposed to, but again it doesn't. My body is pumped -- all day long -- on an empty stomach. Answer? "When appetite is depressed, this part of the cephalic reflex is inhibited," per this link in Wikipedia.

So, after I take a few hours of exercise (garden work), I drink a glass of cold, stevia-sweetened iced tea, in summer with a few dill pickle spears for electrolyte balance. I know that by eating Very Low Carb (LCHF) I maintain a very low level of circulating insulin, and I am, therefore, never hungry. My body knows that it can always access my stored body fat to get all the energy it needs. Thus, it maintains energy balance (homeostasis) and a stable blood glucose without slowing my metabolism. Or so it seems to me.