Type 2 Diabetes, a Dietary Disease #363: Type 2 Diabetes, a Lifestyle Disease

Okay, so which is it? A Dietary Disease or a Lifestyle Disease? It’s both, of course; diet is a part of Lifestyle. But why then is Establishment Medicine comfortable with calling it a Lifestyle Disease and not a Dietary Disease? They would tell you that lifestyle includes such things as doing 175 minutes of exercise a week (which while good, isn’t necessary) and giving up smoking (which while also good, isn’t relevant to diabetes). Forget the epidemiological studies that show an association with Type 2 Diabetes. That’s demographic, not causal.

Exercise is a great habit to have. It builds muscle, keeps you fit, and if you’re a Type 2 or even Prediabetic, it improves your insulin sensitivity. But it’s not necessary. Eating fewer carbs, thereby secreting less insulin, also improves your insulin sensitivity. “Insulin causes Insulin Resistance,” as Dr. Jason Fung recently blogged.

No, Establishment Medicine probably doesn’t want to call Type 2 a Dietary Disease for a number of reasons:

1)  Some clinicians simply don’t know. I know that’s hard to believe, but I’m afraid it’s true. It’s called “tunnel vision.” See #365, to be posted in two weeks, “The Dual Pincers of Clinical Practice Guidelines.”

2)  If you understood that Type 2 Diabetes and Prediabetes are Dietary Diseases, then the “treatment” would be a changed diet, not pills and injections… and you could still advocate for exercise and secession of smoking. Ah, but then it would be a less persuasive and perhaps a less effective argument if it was not linked to the avoidance of Type 2 Diabetes. And, if you didn’t have a prescription to write, the patient would feel “cheated.” The patient wants you, oh omnipotent dispenser of scripts, to “cure” this pernicious disease for them.

3)  If Type 2 Diabetes and Prediabetes are acknowledged to be Dietary Diseases, caused by the dietary advice that Government Dictocrats have mandated and Medical Establishment has peddled for the last 55 years, then your doctor, if he or she were to tell you to change your diet to almost the exact polar opposite of what he or she has been telling you to eat over these many years, they would look pretty silly or just stupid. And the general public, and your doc’s patients in particular, would lose confidence in these omniscient demigods. 

4)  The ADA used to say that low carb diets were not safe. Then, the evidence from controlled trials proved them wrong. Then they said they were safe for a limited time only; then the evidence proved that wrong too. Then they said – actually, they’ve said all along – that low carb diets were too difficult to follow. That’s true for some, but certainly not true for many others. Others found them easier to follow than a low-fat, calorie- restricted, “balanced” diet because weight loss without hunger was possible. And followers of low-carb, high- fat diets, besides keeping the weight off, had better glucose control and better lipid (cholesterol) profiles!

No, it’s easier to see the patient, take a blood sample, and then tell them (in a phone call or a note with your lab test) that, “Your sugar is a little high; we’ll have to monitor that.” And when you continue to eat the same prescribed “balanced” diet, and exercise as you were told, and your blood sugar goes higher still, the doctor will tell you, as Tom Hanks related to David Letterman, “You’ve graduated; you’re now a Type 2 Diabetic.”

Well, what did you expect? You continued to do the same thing and yet you expected a different result? Type 2 Diabetes is a Progressive Disease. Insulin Resistance is a Progressive Condition. Insulin Resistance = Type 2 Diabetes. Insulin Resistance = Carbohydrate Intolerance. The only effective treatment for a Dietary Disease is a different diet. The only effective treatment of Type 2 Diabetes is a Low Carbohydrate Diet. Not “watching your blood sugar” as it progressively worsens. Not treating this symptom – an elevated blood sugar – with a drug that will force your pancreas to secrete more insulin and thus eventually wear out and destroy it. Type 1 Diabetes is a disease of too little insulin. Type 2 Diabetes is a disease of too much insulin. The best way to treat your pancreas, and thus save it, is give it a break! Eat a low carb diet!

Type 2 Diabetes, a Dietary Disease #362: A Stricter Prediabetes Definition?

A recent Reuters Health Information article in Medscape Medical News headlined, “Meta-Analysis Backs Stricter Prediabetes Definition.” It reports on a new study in the BMJ (British Medical Journal) that “people with a fasting glucose as low as 100mg/dl (5.6mmol/L) are at increased risk of cardiovascular disease.” It also showed increased CVD risk in individuals with an HbA1c as low as 5.7% (39 mmol/mol). What is significant about this Chinese study is that it is very large (53 studies, comprising 1,611,339 people). The big takeaway: “Effective intervention in prediabetes is not just for prevention of diabetes, but also cardiovascular diseases.”

This isn’t news to my regular readers. I have been saying it forever, most recently in the risk analysis presented in #345, “How Diabetic Do You Want to Be? (Part 2). That column was based on the laudatory work of Jenny Ruhl at her website, Blood Sugar 101. Jenny has meticulously collected and provided links to the best research. Her books, “Blood Sugar 101” and “Diet 101,” are awesome too.

Based on the ADA criteria for an Impaired Fasting Glucose (IFG) of 100mg/dl to 125mg/dl (5.6 to 6.9mmol/L), the study found that the association between prediabetes and various co-morbidities is as follows: CVD ↑ 13%; CHD ↑ 10%; Stroke ↑ 6% and All-Cause Mortality ↑ 13%. But the ADA criteria is “contentious,” the authors told Medscape, and “has not been used in other international diabetes management guidelines.” The WHO (World Health Organization), for example, uses a higher cutoff for diagnosing an IFG, 6.1 to 6.9mmol/L (110-125mg/dl), and thus has a higher hazard ratio for “composite cardiovascular disease” of ↑26%.

Similarly, the ADA’s prediabetes criteria for an HbA1c is 39-47mmol/mol (5.7% -- 6.4%), whereas the National Institute for Health and Care Excellence (NICE at NHS) cutoff, 42-47mmol/mol (6.0% -- 6.4%), is different. As a result, CVD relative risks vary from 13% (IFG-ADA) to 26% (IFG-WHO), relative risks for CHD vary from 10% to 18%, and relative risks for stroke vary from 6% to 17%. The authors also argue for the standardization of IFG and IGT (Impaired Glucose Tolerance), and the worldwide incorporation of HbA1c in defining prediabetes.

 But let’s not get lost in the weeds. The bottom line is this: The current cutoffs worldwide for a diagnosis of prediabetes are strongly associated with an increased risk of CVD, CHD, stroke and all-cause mortality. This is in addition to the usual microvascular complications of T2DM of nephropathy (end-stage kidney disease), retinopathy (blindness), and neuropathy (leading to amputations). There is also a similar pattern for dementia.

That’s the message, and that is why I am pleased to see this hue and cry for a stricter and more standardized prediabetes definition. The medical doctor’s response was predictable: “People with diabetes should be followed up and should maintain a healthy lifestyle” (emphasis added by me). And “many drugs prescribed for diabetes may be useful in people with prediabetes (metformin, acarbose).” The latter is also not news, but it is surprising how many doctors don’t know this and do not routinely employ this intervention in clinical practice.

Then, according to Medscape, the study’s lead author, obviously a research physician, suggests that, “First, we need to develop models for risk stratification in people with prediabetes. Second, we will select higher-risk people with prediabetes to evaluate whether drug treatment can prevent cardiovascular disease in them.”

I’m not surprised by this either. Drugs, drugs, drugs. Always treat the symptom (an elevated blood sugar); never treat the cause (Insulin Resistance → Carbohydrate Intolerance). What about “lifestyle modifications”?

Lifestyle modifications address modifiable risk factors. That means you can do something to reduce your increased risk of cardiovascular disease. You can modify your diet by restricting the amount of carbohydrates you eat and thus lower your blood sugar. Ruhl #1: ↓Dietary Carbohydrates = ↓Insulin Resistance = ↓Type 2 Diabetes.

Type 2 Diabetes, a Dietary Disease #361: “Whistlin’ Past the Graveyard”

As I write this in mid December, I have just learned that two people that I thought I was helping are paying no attention. This news is worse than discouraging. It’s depressing – but not so much for me. I’m trying not to think of myself. I don’t write this stuff for myself. Okay, I do, a little, but I do it primarily for my friends, my faithful readers, and people who stumble on a column through Google. But it’s especially disheartening to learn that people whose health should be of paramount concern to them…are ignoring their health and my advice.

Okay, I’m not a health professional, and I’m certainly not a doctor. I don’t have the opportunity to order blood tests and deliver the bad news to the patient. And then, when they are most vulnerable, tell them to take a pill or even to follow a certain way of eating. But I can’t for the life of me (LOL) figure out why anyone would listen to a doctor in the matter of what to eat. I mean, what in bloody hell do they know about “healthy eating.”

Oh, I forgot. Government Dictocrats have been telling us what to eat to prevent heart disease since at least 1977, and updating their advice every 5 years. In fact, it began after President Eisenhower’s first heart attack in 1955. By January 1961, Ancel Keyes had made it onto the cover of Time magazine, and the basic advice then and now is to avoid saturated fat and cholesterol, to eat mostly a plant-based diet primarily with fats from corn and soy bean oil. A diet, per the Nutrition Facts Label on processed food, of 60% (300g) carbs, 10% (50g) protein and 30% (67g) of the aforementioned oxidized polyunsaturated vegetable and seed oils (PUFAs) manufactured by the industrial food giant conglomerates supported by the USDA.

Now it’s true that in recent years the USDA/HHS/FDA have backed off a little. They no longer limit total fat to 30%, but they insist that to the extent that percentage is increased, you do it with those PUFAs, not the saturated fats from animals. And it’s true that the Dietary Guidelines Advisory Committee told the full panel on December 14, 2014, that “Cholesterol is no longer a nutrient of concern for overconsumption,” but after the full panel held Congressional hearings, the final 2015 Guidelines totally water down that recommendation.

There are also lots of news articles appearing now about the benefits of full fat dairy products like milk and yoghurt. But guess what? Have you tried to find full-fat yoghurt in the grocery store recently? Good luck! But what do you expect? Do you think the Government is going to tell you their advice for the last 55 years has been all wrong? Of course not. It’s unthinkable. So, you have to decide for yourself what healthy eating is.

I could even cite several scientific reviews questioning – neigh, disparaging the advice to reduce the intake of salt. I’ve cited them over and over here, here, and here. But, does anyone listen to me? No. Poor, poor me.

Recently I learned that one friend who needed to lose weight that he had gained because of medications he must take – was successful in following a low-carb regimen I had advocated. Then, with his wife, he switched to Weight Watchers. Maybe he did it to support his wife’s efforts. Maybe it’s easier. I hope he’s successful.

Then another friend, who also has medical issues, had on the advice of her physician gone vegetarian. And guess what? She’s tired all the time, and blood tests her doctor ordered showed her to be protein deficient. Quelle surprise! She and her husband, who is in worse shape than she, both have ignored my advice for years.

Okay, I am feeling sorry for myself. But I am also worried for them, and for you too – for their health and yours. Don’t they realize that is all they have that is important (besides each other)? Don’t you realize it?

I just learned a few days ago that another friend died suddenly about a month ago. Maybe this rant is because I’m grieving for him too and for all my other friends and everyone else who is whistling past the graveyard. Thinking about myself, I originally thought of naming this column, “Whistlin’ Dixie,” but that would have made this column about me. This is really about you, my friends: It is you who are whistling past the graveyard.

January 1^st is the scheduled publication date for this column. It will also be the 1^st day of the rest of your life.

Type 2 Diabetes, a Dietary Disease #360: Ten years ago, I had a relapse (Part 5)

As readers following this series know, I decided to write it after I stumbled on an old misfiled Excel folder detailing my early “carb counting” days from 14 years ago. After regaining 12 pounds of 60 that I had lost on Atkins Induction in 2002, in 2006 I rededicated myself to Dr. Richard K. Bernstein’s 6-12-12 plan for diabetics. Fifty weeks later, with strict adherence and record keeping, I had lost another 96 pounds. When added to the previous 48 (60 – 12), my loss then totaled 144. I would eventually go on to lose a total of 170 pounds.

In the beginning I still ate a lot, but I did not limit calories, fat or protein. Just carbs. I had a much larger body to feed then and therefore a lot more organism (and psyche) to satisfy. A person who is used to eating, and receives gratification from eating a lot, needs to acclimate him/herself to this new lifestyle. You need to make a gradual adjustment to smaller meals. And you need to shift gratification from a feeling of being full to a feeling of liking that “lean” feeling and seeing the weight loss as recorded every day and every week.

What surprised me (and amazingly my doctor as well), was how, from Day 1 on strict Atkins Induction, the very low number of carb grams had an immediate effect on my blood sugar readings and on my medications. On Day 1 I had a hypoglycemic episode, and several more that first week. My doctor immediately dropped the 3^rd oral anti-diabetic med he had recently started me on and then in successive days that first week, recognizing that I was overmedicated, cut the other two meds, on which I was maxed out, in half twice. In just one week, before weight loss was even noted, I had reduced my diabetes medications by 90% (8/9^ths).

When I started on Bernstein in October 2006, I was still on 5mg Micronase (glyburide, a sulphonylurea or SU) and 500mg of Metformin. I only kept a record of estimated carb grams, and took 4 took blood sugar readings a day: Fasting, 2 hr postprandial, late afternoon (before Happy Hour) and 2 hours after supper. I would later add protein, fat, and calories to my records. Still later I added saturated fat, cholesterol, sodium, fiber and simple sugars (mono and disaccharides, added and naturally occurring). Total sugars were always VERY low.

I kept records in 4-week tables. My goal was simply 30 grams of carbohydrate a day, ala Bernstein’s program.My first 4-week average carb count was 33 grams a day, range 16 to 59, but those were outliers. Most were 20s and 30s. The interesting thing about this month was my blood tests. The fasting average the first week was 139mg/dl. It dropped in weeks 2, 3 and 4 to 107, 104 and 104. But the really interesting result was my late afternoon blood glucose readings. The first week’s average was 85mg/dl. The second week’s was 78, but by the 3^rd and 4^th weeks it had dropped to 59 and 56, with 6 out of 7 readings in the last 2 weeks in the 40s.

On only 5mg of a SU, while eating VERY LOW CARB, I WAS OVERMEDICATED! So, in the next 4-week period I stopped the SU for 2 weeks and then added it back at a reduced dose of 2½mg. My late afternoon averages were now 95 and 114mg/dl for the weeks without an SU, and 57 and 81 for the weeks at the reduced dose. My carb gram average for this 4 week period was 31, down from 33, and very close to my goal of 30.

Not bad, considering this period included Thanksgiving… and Christmas was coming. Oh, by the way, I also lost weight during these successive 4-week periods: 10 pounds the 1^st, 14 the 2^nd, only 1 the 3^rd (including a 150 carb binge on Christmas Eve and on Christmas Day another 94g carb binge). These and a few more seasonal indulgences bumped the December carb gram average up to 51 grams a day. And my weekly fasting sugar averages increased as well in December (105, 109, 111 & 112), but my late afternoon weekly averages held sort of steady (72, 77, 83 & 95) and my evening 2-hr postprandial averages were fine (87, 87, 83 & 95).

In January, I got back to eating according to plan, and my carb gram average dropped to 32 grams a day. Increasingly, however, my late afternoon readings were again dropping below normal (70-100mg/dl), with weekly averages going from 85 to 71 to 67 to 68. So, in the next 4-week period, my average daily carbs dropped to 23! I took no glyburide in week 3, and starting in week 4 I split the tiny pill in half and took just 1.25mg/day. My late afternoon blood glucose average went from 72 to 77 to 95 and back to 87mg/dl.

On March 17, 2007 (end of week 23 on Bernstein 6-12-12), I stopped the sulphonylurea altogether. SU’s are bad news. They effectively lower your blood sugars but at a very big price. They beat up and deplete the pancreas of beta cells and impair its ability to make insulin. Eventually you must inject insulin as your body loses its ability to produce it. 

Type 2 Diabetes, a Dietary Disease #359: Ten years ago, I had a relapse (Part 4)

In Parts 1, 2 and 3 of this series (#356, #357 and #358), I described how I lost 170 pounds on Very Low Carb diets. I related how it all began after my doctor read “What if It's All Been a Big Fat Lie?,” a 2002 NYT Sunday Magazine cover story. He tried the diet to lose weight. After losing 17 pounds, my doctor suggested I try it, also to lose weight. Unfortunately, my doctor soon regained all his lost weight when he went back to eating “normally.” He would afterwards ask me, “What do you eat?” and “How do you do it?” I said, “It’s no secret.”

He also said though, “It might even help your diabetes.” He was sure right about that. Of course, neither of us knew at the time how much it would help my diabetes, but I you’ve read Parts 1, 2 and 3, you know what happened: my Type 2 Diabetes went into total remission. He would probably say that I was “cured,” because I no longer had any symptoms discoverable by the routine lab tests. I am, however, still a Type 2 diabetic because I have Insulin Resistance. I am Carbohydrate Intolerant. That still leaves the questions, “What do you eat?” and “How do you do it?” That’s what Parts 4 and 5 are about.

Ten years ago this past summer, after several years of maintaining my weight at about 315 pounds, I relapsed. I regained 12 of the 60 pounds I had lost on Atkins Induction. That’s when, in October 2006, I started on the Bernstein program for diabetics. I built an Excel table (Fig.1) to keep track of the carbs I ate.

But Bernstein also requires that you limit protein, since some amino acids (digested protein) are glucogenic (can be made into glucose by the liver). So, after a few months on Bernstein, I built a new table (Fig.2) to add protein, and then fat, calories, blood sugars (4 times a day) and weight. I used an online program to get the numbers for everything I ate. It took about a half hour a day at the start, then a little less with practice.

I weighed myself daily, but only noted the change weekly. In the beginning, while I was learning the effect that different foods had on my blood sugar, I took a morning fasting blood sugar (FBG) and a 2 hour post prandial. I also took one in late afternoon (usually my daily low reading) and another 2 hours after supper. Now, since I know about carbs, I only weigh-in daily and take a FBG in the morning to get a weekly average.

I kept a detailed food log for a few years, until I learned what I could eat and what I couldn’t. It was also a good way to show me the price I paid when I ate something I knew was taboo. It had another effect too. Besides the shame and guilt I felt, and the disappointment with myself for the “lack of discipline,” it always ruined my averages. If you’re completely honest with yourself, and record everything, the numbers don’t lie. That was probably more devastating than the guilt! You’ve got to be totally honest with yourself. You have to record everything you eat and drink. No rationalizing. No forgetting! And then, you have to face the truth.

After a while, you won’t need to keep records. You figure out what works. You learn, and then you know that eating certain foods will not spike your blood sugar. And others will. You know that eating fat and limited protein with nil carbs, will not leave you hungry. You will also be able to fast easily because YOU WILL NOT BE HUNGRY. When lunchtime rolls around, you will ask yourself, “Am I hungry?” and if the answer is “no,” it will be easy to skip that meal, or eat a smaller meal, without hunger. And, you will lose your “sweet tooth.”

None of this is to say that you will not want to eat something for reasons other than real need (hunger). For example, the sight of food is a tremendous stimulus for me. It has been my downfall more times that I can count. Nervous eating, bored eating, habit (mealtimes), social events, social convention, (fellow workers and family members) all present challenges. But, need is the only biological imperative, and real hunger is what drives that need. And if you are in a state of mild ketosis, described as “ketoadapted” (Google it!), your body is content with burning body fat for fuel. So, my new mantra is to ask myself, “Am I hungry?” If the answer is “no,” I try not to eat. But, if I succumb for whatever reason, I eat a small meal of just protein and fat.

Type 2 Diabetes, a Dietary Disease #358: Ten years ago, I had a relapse (Part 3)

When I told my wife that I was writing a series about my weight loss journey since I started Bernstein 10 years ago this fall, she asked me if that was the year we were in Puerta Vallarta in September. I checked and it was. What a memory she has! My recollection was a little different…

As I related in “Ten years ago, I had a relapse (Part 2),” I recalled that my motivation was that I had regained 12 pounds (20%) of the 60 pounds I had lost on Atkins Induction (20g a day of carbs) back in 2002-03. That was true, but my wife reminded me of a conversation I had had with a Canadian MD I met in Mexico who told me that I was “IN DENIAL.” What a service that doctor did for me that day!

I came home with renewed resolve to do something about that 12 pound weight gain. Having just read Richard K. Bernstein’s “Diabetes Diet,” I bought and read his Diabetes Solution  and decided to go for it: eat just 30g of carbs a day. For medications, I was still 5mg Glyburide and 500mg of Metformin a day.

Beginning in October 2006, I started counting carbs and taking blood sugar readings again (see Fig.1  ). By November ( Fig.2), I had cut back the Glyburide from 5mg to 2½. In late January (Fig.3), I started a 4-week drug trial to reduce it further from 2.5mg to 1.25. And in late February (Fig.4), I started limiting proteins, since so many of their component amino acids are glucogenic, i.e., are made into glucose by the liver.

Then, on March 17,^, 2007, I stopped taking Glyburide altogether. By April I was eating just 90g of protein a day (see #357 for how I chose this amount). In May, I reduced protein further to 80g/d. I also reduced my fat intake from 110 to 100 to 90g/day. By September 23, 2007 (Fig.5), 50 weeks after starting Bernstein, I had lost 96 pounds, going from 327 to 231. Added to the 48 net (60-12) that I had lost on Atkins Induction, my total weight loss from 375 pounds to 231 on both Very Low Carb diets, was 144 pounds…with more to come.

Remember too (or if you didn’t, read #356 here), starting with the first week on Atkins Induction back in 2002, I had stopped taking all of my oral anti-diabetic medications except 500mg Metformin and 5mg Glyburide.  Now I was only on 500mg of Metformin, which I was to continue for the next 14 years.

With all the weight loss, my blood pressure also improved significantly, on the same pill “cocktail.” It went from 130/90 to 110/70 at my lowest weight (late 2008). Currently it’s 120/75. And my lowest A1c was 5.4%.

Now, returning back to late 2003, after a year of monthly office visits while monitoring my 60 pound weight loss and maintenance while on Atkins Induction, my doctor suggested we change to quarterly visits. My Total Cholesterol and LDL-C hadn’t changed much. They were both “borderline” by NCEP Guidelines for a “healthy” person. But, based on my still “morbidly obese” status, and Type 2 diabetes, my doctor declared that I was still at “high risk” for cardiovascular disease, so he put me on a statin. He started me on Lipitor, and quickly raised it to the max. My LDL-C (and Total Cholesterol) responded as expected. They plummeted.

But, prior to my starting statins, on both Atkins Induction and Bernstein, my HDL-D and triglycerides both improved a little. Before starting Atkins, my average HDL-C had been just 39mg/dl and my TGs 143mg/dl. Now, my HDL was 51 average (range 43 to 60) and my triglycerides 84 average (range 36 to 157). As I continued from mid-2004 to mid 2007 on both Bernstein and a generic statin, Simvastatin, my TC and LDL-C were very, very low (TC: 116 & LDL-C: 48, average of 12); however, since starting on Bernstein, my HDL-C soared and TGs crashed. My HDL-C average was now 84mg/dl and my TGs averaged 49mg/dl.

Given the death-from-all-cause benefit of a high HDL-C and low triglycerides, and my total weight loss (by this point 170 pounds), on first, Atkins Induction, and then Bernstein, in December 2008 my doctor (on his own!) took me off statins. I have been statin-free now for 8 years. And while my weight has inched up a little, my latest lipid panel was Total Cholesterol 184, HDL-C 91, LDL-C 84 and triglycerides 46. How’s them apples?

Type 2 Diabetes, a Dietary Disease #357: Ten years ago…I had a relapse (Part 2).

As I started to tell you in #356 here, ten years ago this past summer, I had a relapse. I regained 12 of the 60 pounds I had lost over a nine month period 4 years earlier. I had lost focus. So, I decided that it was time to get serious again and rededicate myself to the principles and practice of the Very Low Carb Way of Eating.

That summer of 2006, 10 years ago, I also read Dr. Richard K. Bernstein’s book, “The Diabetes Diet.” So, with my renewed resolve, I decided to switch to Bernstein’s Diet Plan for Diabetics. Dr. Bernstein has been a Type 1 Diabetic for most of his 70-odd years and was an engineer before he became an MD, like his wife. She had a big blood sugar testing machine in her office, so he used it to develop a strict regimen for “eating to the meter.” After all, he reasoned (as an engineer), if carbs make your blood sugar rise, the best treatment for regulating your blood sugar would be to restrict carbs. That makes sense doesn’t it? It’s just common sense!

Bernstein’s credo is that “everyone deserves a normal A1c.” His is in the 4s. Being a Type 1, he achieves this by injecting insulin, both 24-hour and at mealtimes, on a 30g-of-carbs-a-day plan. He calls it 6-12-12: 6 grams at breakfast (lower due to what he calls the “Dawn Phenomenon”), 12g at lunch and 12g at supper. No snacks. These principles are all well documented in the latest edition of his book, “The Diabetes Solution.”

Another difference from Atkins Induction is that Bernstein limits protein. When digested, protein breaks down into amino acids, from which some are made into glucose by the liver and thus raise your blood sugar. So, to limit this unwanted glucose production (called gluconeogenesis), protein needs to be limited. But how much protein should a person eat? In 2006 I studied the question carefully and discovered that opinions vary widely, but the “correct” way is to use a number based on an estimate of ideal, or lean body weight.

Lean Body Weight is the optimal weight for a person, and it is your lean body that needs protein. In 1998 the HHS/NIH adopted the Body Mass Index (BMI) Chart used by WHO, the World Health Organization. Your doctor is required to use this chart to “evaluate” your weight. It is a really gross metric that takes no account of gender, body type, or your cultural environment. It is also a pie-in-the-sky number for almost everyone who will read this post, i.e. people living in a part of the world where food is abundant and where processed food has replaced real food in our lives. Thus, according to the BMI, most of us are now overweight or obese. Nevertheless, your BMI “normal” weight is what you should use to calculate the amount of protein to eat.

The middle of the “normal” range in the BMI chart for a 5’-11” person (me) is 150 pounds. I still weighed 300 pounds in 2006, so that sounded totally ridiculous to me, so, by “mistake,” I chose instead a “goal” weight of 180 pounds for my calculation. And since I was pretty sedentary and did no exercises, I used 0.5 grams of protein per pound (1.1g/kg) of my goal body weight. So, 180 x 0.5 = 90 grams of protein a day. Honestly, though, the grams per pound is also a variable where opinions vary widely, so the number you settle on is up to you. That’s how I started. Note: I was soon to reduce my protein budget further, but not the carbs…yet.

For fat, I followed Bernstein’s dictum: Eat enough to be satisfied. I didn’t avoid saturated fat or cholesterol. I was convinced by Taubes, and others by this point, that the 1977 “Dietary Goals for the United States” and The Dietary Guidelines from 1980 on, every five years thereafter, were a failed Public Health experiment and were in fact the cause of our obesity and diabetes epidemic. And they certainly weren’t the right diet for anyone who was diabetic, pre-diabetic, or had even a touch of Insulin Resistance. It just didn’t make sense.

So, for breakfast, I usually ate 2 fried eggs and 2 strips of bacon, with coffee and whole cream. That’s all. No juice. No bread. No jelly. No fruit and No cereal. Period! No exceptions. I found this small meal very satiating. I wasn’t hungry later in the morning or even at lunch time. I ate something though – out of habit – but it was usually a couple of hard boiled eggs, or later a can of sardines in olive oil or kippered herring in brine. Yum.