Retrospective #455: Are red grapes healthier than green grapes?

I’m not kidding. A friend, who is a recently diagnosed, insulin-dependent type 2 diabetic, asserted that he ate red grapes in preference to green grapes because they are healthier. When I strongly disagreed, he said, “Red grapes have resveratrol in the skins, and resveratrol has health benefits.” I don’t attribute this point of view to ignorance. He’s a bright, generally well-informed guy. I attribute it to a combo of denial and rationalization.

My friend is on insulin injections because he couldn’t tolerate Metformin or Januvia (a DPP-4) and a SGLT2 was counter-indicated. His fasting blood glucose (FBG) was so high (225mg/dl) his doctor knew she had to get his blood sugar under control as soon as possible, and she thought that injecting insulin was the only, if not the best, way to do it. With fasting blood sugars that high, I couldn’t disagree, but only because they were so out of control.

(In my own case, in 2002, after having been a diagnosed T2 for 16 years, and maxed out on a sulfonylurea (SU) and metformin and starting a 3^rd oral (a TZD), my FBGs were also out of control but just in the 150s. My doctor believed (at the time – it seems like ancient history) that T2D was caused by obesity (I weighed 375 pounds), so he suggested I try eating VERY Low Carb, or VLC (20g of carbs a day), to lose weight. He had just read about it in a New York Times Sunday Magazine cover story by Gary Taubes, “What If It's All Been a Big Fat Lie,”

So, I began the Very Low Carb (VLC) program “cold turkey” and within the first week I had several hypos. By phone my doctor ordered me to stop taking the TZD and then the very next day (after another hypo) to cut the SU and the metformin in half. Later that week, after another hypo, and he told me to cut them in half again. I later discontinued the SU altogether.)

So, as a newly diagnosed T2, my friend surely had a steep curve to learn about carbohydrates and his glucose metabolism. Type 2 diabetes is a dietary disease. His body’s ability to process glucose, the compound into which virtually all carbs break down, is impaired due to a condition called Insulin Resistance, developed over many years, decades even. As a result, his body doesn’t “take up” glucose easily.  He is thus Carbohydrate Intolerant – intolerant of all carbs, red and green grapes alike, and all other fruit and all starches too. They are all carbohydrates.

Fruits are just sugar and water. Your body doesn’t give a wit that they contain “natural sugars.” Your body processes “natural sugars” and “added sugars” the same way. Fruit sugars are mostly sucrose, a disaccharide made up of one molecule of glucose and one molecule of fructose, plus some free fructose and free glucose (monosaccharides). The fact that whole fruits have fiber or other micronutrients is just as irrelevant as the color and content of the skin of the grapes. They are inconsequential to you, compared to their glucose content.

To think otherwise is to deny the consequences to your health of ignoring the truth. You are Carbohydrate Intolerant. Red grapes have the same glucose content as green grapes, period. I’m sorry, but that’s the truth.

According to the USDA database, “grapes (red or green), European type, such as Thompson seedless, raw,” are 80% water and 18.1% carbohydrate, of which 15.48% are simple sugars. The remaining carbs are oligosaccharides (long chain “sugars” . There are also trace amounts of protein, fiber and ash. Each grape contains 3.5kcal, about 1g of carbs.

Now wine, that’s a different matter. LOL. Most carb counters say that a dry white table wine has fewer carbs than a dry red table wine (3 vs. 4). It depends, of course, on the specific wine, but according to the same USDA database, a typical 5 oz glass of Chardonnay (white wine) is said to contain 3.18g of carbs, and a 5oz glass of Cabernet Sauvignon (red wine) is said to have 3.82g of carbs (thus 3 vs. 4). But the total calories in each are the same (123 vs. 122kcal). The difference is that the white wine tested had a slightly higher alcohol (fermented sugar) content (15.7g vs. 15.4g).

And while pure ethyl alcohol (spirits) has more calories per gram than carbs (7 vs. 4), it does not raise blood sugar, as glucose does. A glass of wine, however, is a combination of alcohol and carbs and, in moderation, will raise your blood sugar somewhat. So, bottoms up, tipplers, but don’t eat grapes, red or green. You’re grape intolerant!

Retrospective #454: “Are vegetable chips okay?”

At a poolside lunch with friends last summer, my wife served a popular brand of “real vegetable chips” as a side dish. Later, as I helped return the uneaten chips to the bag, out of curiosity…I looked at the nutrition label.

A one ounce serving contains 16 grams of carbs, including 3 of fiber and 2 of sugar, with 0 grams of “added sugar.” It also contains 1 gram of protein and 9 grams of fat, of which 0.5 grams are saturated.

What the label doesn’t tell you (because they don’t have to) is that the remaining 11 grams of carbohydrates are starches (long chain glucose molecules) from “diverse root vegetables” that have been milled and are easily digested. The 2 grams of sugars inherent in the tuberous ingredients are combinations of monosaccharides (100% glucose) and disaccharides (50% glucose/50% fructose). So, the unnamed carbs from the starches (100% glucose) will raise your blood sugar faster and higher than the 2 grams of simple sugars. 

The label also doesn’t tell you (because they don’t have to) that the other fats in this manufactured “food” product are all unsaturated fats, the vast majority of them polyunsaturated (PUFAs). The actual percentage is not determinable because the label says the product includes, “expeller expressed Canola oil and/or safflower oil and/or sunflower oil.” So, who knows what percentage of which oil was used, or if it was all just one of them?

Of course, “expeller expressed” canola oil is listed first because that would be the best of the worst. “Expeller expressed” means it is less processed and refined. And of the three “seed” oils, Canola oil has the highest percentage of the good monounsaturated fats. But the other “and/or” seed oils are not “expeller expressed.” Just “processed.”

Rounding out the ingredients list, after tubers, PUFAs and sea salt is “beet juice concentrate (color).” Note: the word “color” is within the quotes lest you should think they added “beet juice concentrate” as a sweetener. But just in case you weren’t aware of it, the USDA reports that beet sugar production is almost 50% greater than cane sugar production in the U. S., and sugar beets for food use is 1½ times greater than sugar cane for food use. Do you think the beet sugar juice in these chips is used just for color, as they say? I don’t. But the USDA allows the label to say this.

It’s just another deception, but I’ll get to that in a moment. First, let’s admit the consumer is a willing dolt. We are prepared to be snookered by clever marketing to assuage the guilt we feel for eating something that we know in our hearts (pardon the double entendre) is bad for us. These days, the bogey man is “added sugar,” so labels now have the new subcategory “added sugar.” This has recently been added to the requirement that it specify “saturated fat,” but not polyunsaturated fat, or refined starches, arguably much, much worse for our health.

But here’s the contradiction and irony: “Vegetable chips” are a manufactured “food” product. They are not a whole, unprocessed food with inherent sugars, such as the “taro, sweet potato, batata, yuca or parsnip” from which they are made. There is no Nutrition label on taro, sweet potato, batata, yucca or parsnip. So, I could understand how you could claim that there were no “added sugars” in these whole foods, although we’d have to ignore the successful efforts of agronomists to hybridize fruits and vegetables to make them sweeter. But that’s not the case here. These “vegetable chips” are heavily processed in manufacture and the beet juice is added (for color, of course).

So what have we got here: You take a natural whole food, mill it, process it and refine it, then add a sweetener camouflaged as an additive for color, then cook it in highly processed, inflammatory, oxidized and unnatural fat and you get a snack food with a nutritional halo: “real vegetable chips.” Good marketing, for sure..

I’m sure the USDA rule that allows a snack “food” manufactured from processed and refined tubers (starchy root vegetables), combined with unhealthy, polyunsaturated seed oils, and sugar juice concentrate to create a product that has by definition, no “added sugar,” is a common practice. But then, I don’t think adding the sub-category “added sugar” has any meaning or value, except to delude us and help the consumer (and the lobbyists and politicians who made the law) feel good. So, just, eat your “vegetables” and forget it.

Retrospective #453: Fish oil supplementation, triglycerides and platelet formation

Eighteen years ago, I began taking 4 grams of fish oil a day (plus a can of sardines for lunch!) After a few months, I lowered the fish oil to 3 grams and then to 2, which I take to this day. During this time I dramatically lowered my triglycerides from 143mg/dl (aver. of 11 tests) to 49mg/dl (aver. of 25 tests) 5 years later.

In discussing fish oil supplementation with a friend recently, the risk of high-dose fish oil “causing bleeding” came up. Googling “fish oil, bleeding” dredged 2 articles at Evidence-Based Medicine Consult (EBM Consult), a free searchable, online medical education database. The first discusses the mechanism for how Omega-3 fatty acids could increase the risk of bleeding; the second discusses the bleeding risk. Both were revelatory for me.

“As it relates to CVD, fish oil is most commonly used to treat high triglycerides. When clinicians refer to the use of ‘fish oil,’ they are generally referring to omega-3 fatty acid, a polyunsaturated fatty acid (PUFA)). This specific omega-3 fatty acid includes both DHA and EPA compounds. For the most part, neither DHA nor EPA causes any major side effects or clinically relevant drug interactions, but they are known to influence platelet formation.”

“As such, some clinicians perceive that this can put the patient at greater risk of bleeding, especially during surgical procedures or while on medications that are known to affect coagulation and platelet aggregation.” So, if you’re going to have surgery, or you have CVD and take Coumadin (Warfarin) or another blood thinner, your doctor might advise you against taking more than 1 gram of fish oil, or to stop taking it before surgery. 

In the mechanism article, what caught my attention was not about bleeding but about platelet aggregation. It turns out “omega-3 fatty acids compete with [the omega-6] arachidonic acid (AA) for incorporation into the platelet cell membrane, thereby increasing the ratio of omega-3 fatty acids:AA.” In other words, they inhibit platelet aggregation.

I’ve been writing for years that the Standard American Diet (SAD) is very high in omega-6s, with a ratio of omega-6 to omega-3 of at least 20 to 1 (20:1) vs. the 2:1 or 1:1 ideal. And that supplementation with fish oil alone is not enough to reverse that ratio. We must also lower the Omega 6’s by avoiding fried foods and “vegetable” (seed) oils, baked goods and some nuts. It seems I may have been too successful at taking my own advice! For the last 11 years my Complete Blood Count (CBCs) have consistently been slightly out-of-range on platelet (and related) counts.

The EBM Consult site is intended to educate doctors and other medical professionals, but the gist is still comprehensible to me. Too much DHA and EPA from fish oil supplementation has anti-platelet effects that 1) interfere with intracellular pathways, 2) increase prostaglandin formation and 3) decrease the production of platelet activating factors. Eureka, my overcorrected ratio may be the cause of my out-of-range CBC counts!  (NB: the cause, my doctor thinks, may instead be the radiation therapy I had many years ago that could have killed some stem cells that create new red blood cells.)

The other EBM Consult article, concerning the bleeding risk, concludes with a simple (paraphrased) message:

●        The AHA recommends 1 gram of fish oil per day for patients with coronary artery disease and 2 to 4 grams per day for patients with high triglycerides. They also advise those who take more than 3 grams per day do so under the care of a physician “since high doses could cause excessive bleeding in some patients.”

●        In an analysis by the National Lipid Association, of 4,357 patients who took 1.6 to 21 grams [not a typo!] of DHA/EPA per day in combination with some type of prescription anti-platelet or anticoagulant, only 1 patient developed blood in their stool and 1 other experienced a gastrointestinal bleed.

●        Clinical trial evidence to date does not support an increased risk for bleeding in patients taking fish oil supplements…even when combined with other medications known to increase the risk of bleeding [!].

If you take more than 3 grams of fish oil a day, or have out-of-range Complete Blood Count (CBC) labs, or are concerned about bleeding, you should read these two EBM Consult articles. Otherwise, I would conclude that taking fish oil supplementation is a good way to treat high triglycerides. It sure worked with me, to a fare-thee-well.

Retrospective #452: The most common cause of high triglycerides is…

High blood sugar! “The most common reason for having “high” blood triglycerides (over 199 mg/dL) is blood sugar. If your cells are resistant to insulin, their ability to take up glucose is impaired, and so they turn to fatty acids for fuel. They get these fatty acids from triglycerides, put into circulation by the liver. “If you are a [type 2] diabetic, your diabetes can increase triglycerides significantly, especially when your blood sugar is out of control.”

I found this unattributed quote in a draft Word file while searching for documentation to answer the question, “Will eating a high fat diet raise my triglycerides?” The question was asked by a recently diagnosed, insulin-dependent type 2 diabetic I was mentoring who has high triglycerides. Naturally, he was concerned with my suggestion that he self-treat his diabetes with a Very Low Carb, High Fat diet. Unfortunately, the quote is without attribution! 

The goal of a VLCHF diet do is to lower both blood glucose and blood insulin. Lower blood glucose obviously means better diabetes control. Lower blood insulin will make the body more insulin sensitive and thus less insulin resistant. Lower blood insulin will also enable the body to access and use visceral or internal, abdominal fat for fuel. Along with weight loss, it will also help to “clear” a fatty liver and restore pancreatic insulin production.

Think about it. High blood sugar means that the refined carbs and simple sugars in your diet have been digested and are still circulating in your blood (as glucose)! Because of the Insulin Resistance you developed from eating this way, glucose is not being taken up by your cells for energy. And you can’t access your body fat for energy because of your high blood insulin levels, so…YOUR LIVER HAS TO STEP IN AND MAKE TRIGLYCERIDES TO USE FOR ENERGY. Ergo: You have high glucose, high insulin and high triglyceride levels! They all go together!

Solution: Treat your high blood glucose with a VLCHF diet. This will lower both your blood glucose and your blood insulin. This in turn will allow your body to break down body fat to simple fatty acids for energy, and eliminate the need for your liver to make triglycerides. You won’t be hungry because your body will be well fed with these fatty acids; you will improve your insulin sensitivity by secreting less insulin because you’re eating VLC; your pancreas and liver will both do less work. Your liver won’t be forced to make and circulate triglycerides.

Eating VLCHF will lower your blood triglycerides. But, before testing for triglycerides, be sure not to fast for too long (more than overnight). Prolonged fasting will raise your blood triglycerides temporarily especially if you are already eating VLCHF and are “fat-adapted.” In a prolonged fast you use body fat (fatty acids from triglycerides) for energy.

I have never had “high” triglycerides. Before starting VLC in 2002, my average triglyceride lab score (11 tests) was 143mg/dl and my HDL-C was a low 39mg/dl. Five years later, after I’d lost 170 pounds eating VLCHF, my average triglycerides from 2007 to 2014 (25 lab tests) was 49mg/dl and my HDL-C 75mg/dl. Of course, by then my type 2 diabetes was in remission, and with the weight loss my blood pressure was greatly improved. My latest labs (Aug 2018): TG 56mg/dl; HDL-C 92mg/dl; TC 189mg/dl; LDL-C 83mg/dl (Martin/Hopkins calculation).

These results are just mine (N=1), but lab reports like these are widely reported by people who eat VLCHF. I’m confident that if you commit to make this permanent lifestyle change, you will see similar results.

Type 2 diabetes and obesity (aka diabesity) are central components of what is now known as Metabolic Syndrome. Look it up. It is the result of the way we have been told to eat. It is called the Standard American Diet, or SAD, appropriately. To reverse Metabolic Syndrome, get control of type 2 diabetes, lose weight and lower your triglycerides, you need only to change what you eat. A Very Low Carb High (Healthy=Saturated) Fat diet will do it. The only question is, do you have the guts to try it? If you do, and you stick with it, you won’t be disappointed.

Remember, lower blood glucose, lower blood insulin and lower triglycerides (plus higher HDL-C) go hand-in-hand. Your blood sugar will be low and stable – your doctor will say, “in control” – and the only “side effects” will be lower weight and lower blood pressure, plus fewer expenses for drugs.

Retrospective #451: Is Very Low Carb like the South Beach Diet?

When I describe my Way of Eating (WOE), I’m frequently asked, “Is Very Low Carb like the South Beach Diet?” Definitely not! Here’s a point-by-point comparison, from my (biased) perspective as a strong advocate of the Very Low Carb approach. For reference, I’ve used this description of the South Beach Diet from Wikipedia.

SBD: “high in fiber,” “low glycemic carbs,” “unsaturated fats (mostly monounsaturated),” “lean protein.”

VLC: Very low in fiber. All fiber is carbohydrate. You cannot eat both “high fiber” and Very Low Carb because, to get any fiber, you have to eat carbs, and to get high fiber you would have to eat too many carbs. The only fiber you eat in Very Low Carb is the incidental content in some of the low carb vegetables at some meals (supper, mostly), and the occasional snack (e.g. celery with anchovy paste). Typically, I eat maybe 5g of fiber a day.

SBD: Unsaturated fats (mostly monounsaturated): This suggests avocado and olive oil (mostly monounsaturated), but the SBD would necessarily include all processed and refined seed (“vegetable”) oils: soybean, corn, sunflower, Canola, etc, all polyunsaturated, all highly processed and oxidized, and all bad. The SBD implicitly excludes saturated fat: butter, ghee, coconut oil, tallow, lard, the latter two found in animal meats.

VLC: Includes monounsaturated fats (avocado and olive oil) and saturated fats as listed above, all as found in meats and dairy and used in cooking. No margarine. It is a refined seed oil and may contain trans fats (partially hydrogenated oils). We love to cook with bacon fat. My wife makes pie crusts with lard (not Crisco). I brown meats in ghee.

SBD: “lean protein.” Wikipedia doesn’t even mention the words “red meat” in the SBD piece! Or dairy either.

VLC: For VLCers, the fattier the meat, the better, including ground meats, lamb chops, chicken with the skin on, and pork roast. Salmon and sardines too, and full-fat yogurt (if you can find it!), heavy cream, and full-fat cream cheese.  All saturated fat! It will raise your HDL-C. My last HDL-C was 92mg/dl, my TC 189, my LDL-C 83 and my trigs 56.

SBD & VLC: Generally, both diets advocate “low glycemic carbs.” This would include many above ground vegetables and leafy greens. VLC would exclude corn, beets, peas and carrots (too sugary) and of course all tubers. My favorite vegetables are broccoli, cauliflower, asparagus, green beans and salad greens. More caveats below.

SBD: “3 steps,” “emphasis on carbs,” “exercise included”, “3 meals + 2 snacks a day,” a “high-fat” diet.

VLC: The best way to do Very Low Carb is “cold turkey.” In 2002, I started on 20g of carbs a day. My motivation, and the reason my doctor suggested it, was to lose weight. But within the first week, to avoid hypos, my doctor took my off virtually all my diabetes meds. Today I just take Metformin. And, over a period of years, I lost 180 pounds.

SBD: “with emphasis on carbs.” Wikipedia says Phase 1 includes “many carbs,” and Phase 2 includes “complex carbs” such as “brown rice” and “100% whole grain bread.” I can only imagine what Phase 3 allows you to eat!

VLC: Very Low Carb also emphasizes carbs, but just the opposite: you eat as few carbs as you can, but when you do you eat carbs choose ‘low-glycemic’ carbs and definitely no rice or bread (or pasta or potatoes, etc.), ever.

SBD: “choose the right fats and the right carbs,” “a ‘high-fat’ diet, not a ‘low-carb’ diet”

VLC: If you are a type 2 diabetic, you are insulin resistant and therefore carbohydrate intolerant. You need to make a permanent change in what you eat. Very Low Carb is not a temporary diet where you return to eating the foods you ate before. You’re not doing this to lose weight – although if you follow it strictly, you will lose weight (lots of it). You’re doing it to self-treat (through diet) your type 2 diabetes and avoid the dreaded complications.

When you eat VLC, your body will burn body fat, so it won’t be sending you hunger signals, and you will be able to eat fewer meals (just 1 or 2 a day), with NO between-meal snacks – and you won’t have to exercise if you don’t want to.

VLC & SBD: Both are “high-fat,” but saturated fats taste much better than those refined “vegetable” oils.

Retrospective #450: When and what to eat, and not eat

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.

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.