Retrospective #496: Maintaining “Half the Man I Once Was”

In The Nutrition Debate: Type 2 Nutrition #400, I related how after years of eating Very Low Carb, with ups and downs and many misadventures, and finally with an excursion into Extended Fasting – both alternate day and consecutive day – I achieved a weight loss result I could never even have imagined at the start: I was just half the man I once was.

It all began with my doctor’s suggestion in 2002 that I begin a program of eating Very Low Carb (20g of carbs a day), to lose weight!  I weighed 375 pounds. After 15 years of on-again, off-again compliance – even some periods of outright cheating – I finally weighed in at 187 pounds. My BMI went from 54 to 27, and I was just half the man I once was.

As everyone who has lost a lot of weight knows, the challenge at that point was to maintain that loss, or at least most of it. Alas, I failed. In the ensuing months, I regained and then lost some of the weight. Along the way I thought a lot about my attitude toward food, including the cultural influences and the emotional drivers that influenced the eating habits and patterns that I had acquired over a lifetime. That’s a lot to know, and my introspection was not perfect.

One thing was certain though: Carbohydrates drove my weight gain and regain. I had been diagnosed a type 2 diabetic in 1986, at age 45. I had probably begun to develop Insulin Resistance in my early teens (I remember when and how and why.) By the time I reached middle age, I was Carbohydrate Intolerant, Insulin Resistant and a full-blown type 2.

Reading Gary Taubes’s New York Times seminal piece, “What If It’s All Been a Big Fat Lie,” gave my doctor and them me the confidence to try Very Low Carb. Reading Taubes’s tome, “Good Calories, Bad Calories” (“The Diet Delusion” in the UK), gave me an understanding of the science of insulin resistance, type 2 diabetes and obesity (“Diabesity”). It also explained Metabolic Syndrome and Gerald Reaven’s associated Unifying Theory of Disease. When I started to write about type 2 diabetes on Blogger in 2010, Gary Taubes was the subject of The Nutrition Debate #5.

An important factor in my early adoption of eating Very Low Carb was the online community. I became a regular at The Bernstein Forum, first as a lurker, then as an active participant to learn more, and later as a sort of mentor to others. I had lots of questions, and members of this community were very supportive of Very Low Carb eating. In no time at all (it seems), I had lost 170 pounds. Seriously, support in a friendly environment is very conducive to learning.

Another influence, long before he (they) became the blockbuster enterprise they are today, was Andreas Eenfeldt at DietDoctor.com. It was Andreas who, in a timely January post some years ago, available as an inducement to becoming a monthly subscriber (which I recommend), suggested a 5-point manifesto. Rule #1 was, “Eat only when you are hungry.” This was so valuable on so many levels: a) think before eating, b) question cultural norms and habits, and c) remind yourself of the primary purpose of eating: nourishment to maintain energy balance (if required by eating).

That last point became clearer when I thoroughly understood the role of the hormone insulin in energy management: If your body has access to stored energy (body fat), possible only when you have a low level of circulating blood insulin, in turn made possible by a low level of glucose in the blood, your body will be both nourished and in energy balance.

So, returning to where I began this post, my goal now is to be forever in ONEDERLAND. Onederland is the world in which, when you step on the scale, the first number you see is a “1.” Does that sound like fantasy to you? It did to me, at one time. But when eating Very Low Carb worked, for losing weight easily and without hunger, it was just a matter of one-day-at-a-time, then one-week-at-a-time, and with every passing month, the goal became closer to reality.

In my case, my goal for the rest of my days on this planet is to maintain my weight between 195 and 199 pounds. I will do this with a combination of generally following the principles of Very Low Carb (VLC) and One Meal a Day (OMAD). I will include protein every day, including whatever saturated fat is inherent in it. In fact, I will choose fatty cuts and always eat full fat dairy, including heavy whipping cream in my morning cup of coffee. I will otherwise eat only a moderate amount of fat, to allow my body to burn its own fat, and I will avoid as much possible all unnatural PUFAs.

Finally, I will use full-day fasting, as often as needed, to keep my weight within my Onederland range. Wish me luck!

Retrospective #495: “A Very Low Insulin Diet”

I’ll bet you’ve never heard of this diet! Am I right? Well, if you haven’t, it’s because there isn’t a diet as such. It’s an outcome actually, of eating a certain way that achieves a low blood insulin level.  And that is a very good outcome, as I’ll explain. It’s also the natural outcome, as I will show, of eating the way our ancestor ate. The problem is there’s no way yet of knowing, objectively, from a simple (inexpensive) blood test, that you’ve achieved that desired outcome.

As a consequence, once you have achieved this outcome – until a cheap blood test is available – you will have to rely on a surrogate marker to know if, how and when you have achieved your goal: a low blood insulin level.

To understand “how,” we’ll need to delve into a little basic human physiology. Insulin is a hormone that has multiple roles in metabolism and fat partitioning. It is secreted by the pancreas, a small gland near the stomach, in response to eating carbohydrates. And as carbs are digested into glucose, insulin accompanies them into the bloodstream and acts to “open the door” of the cells where the glucose is taken up for energy.

So, when you eat carbs, your blood insulin level naturally rises. And the glucose from the carbs you ate are in excess of your energy needs, they are stored or, when storage is full, by a process called de novo lipogenesis, the liver converts them to fat and stores them in your fat cells. Then, as the circulating glucose is absorbed and burned or stored or converted to fat, your blood insulin level drops. And that is what a normally functioning glucose metabolism does.

Then, in that normally functioning glucose metabolism, when you blood insulin level goes low between meals, when you body calls for energy for whatever purpose (basal metabolic or activity), your low blood insulin level signals the liver to take energy from those recently refilled or other fat cells. Your fat cells cycle the triglycerides back into your blood stream (broken down as free fatty acids), and you get all the energy you need from your stored fat. Again, that is what a normally functioning glucose metabolism does. A low blood insulin level allows your body to continuously access stored body fat to maintain energy balance, including any level of energy required by your activities.

But what happens if for years and years, to avoid “saturated fat and cholesterol,” you have eaten – as you’ve been told – a diet very high in carbohydrates? And what happens if that diet, for your “convenience,” is mostly processed carbs from prepared foods or products sold in boxes and bags? And what if, to make the food more “palatable,” sugar (a simple, easily digestible carb) is added to virtually all processed foods, e.g., store-bought bread or peanut butter?

What happens is that for many people the body resists the unnaturally high level of glucose in the bloodstream. The transport hormone – the insulin accompanying glucose in your blood, it unable to open the cell that needs the energy. Those cells have developed Insulin Resistance. Well, the glucose and the insulin, continue to circulate, the cells don’t get the glucose energy they need, and because your blood insulin level is still high, your liver can’t access your stored body fat for the needed energy. So, your metabolism slows, and you feel tired… and sluggish…and hungry.

If you are one of those who has developed…over many years…a degree of Insulin Resistance, your doctor has no direct measurement to find out. He doesn’t have an affordable or insurance reimbursable test that he can use to measure your blood insulin level. But she, and you, have a few good surrogates: 1) you body fat level. The cause of obesity, or “overweight,” is not sloth or lack of activity. It is Insulin Resistance. If you have a “touch” of Insulin Resistance, your elevated blood insulin is being transported back to your liver where it converts it to fat, and your elevated blood insulin is blocking body fat from being used for energy when your body needs it, so you’re hungry and you eat for energy.

Another surrogate is an elevated blood glucose level. Your doctor can easily test for this, either with a hemoglobin A1c test which measure the glucose on your red blood cells over 3 months. This is a good surrogate because, as we say, if you have an elevated blood glucose, it is because you have an elevated blood insulin because of Insulin Resistance.

If you have Insulin Resistance, the precursor condition for Type 2 Diabetes, you can treat it yourself by not eating the foods that make your body produce and transport insulin to help your body take up glucose: CARBOHYDRATES.

Retrospective #494: My Simple Food Rule

My “food rules” haven’t changed much since I started eating Very Low Carb in September 2002. At the my doctor’s suggestion, to lose weight, I began with Atkins Induction: 20 grams of carbs a day. It worked in the way my doctor intended. I lost 60 pounds in 9 months. It also worked in another way that was unintended, or at least not anticipated. In the 1st week I had to come off nearly all 3 oral diabetes medications that I was on.

As best I can remember, the Atkins protocol only addressed carbohydrates at the time . That’s worth noting. It’s only – okay, well largely – only carbs that matter. To lose weight (lots of it – I eventually lost 180+ pounds), you only need to restrict – severely, I’ll admit – CARBOHYDRATES.

So, if all you need to know, to lose lots of weight and greatly improve your health, is to severely limit the carbs you eat, the first thing you need to learn is: what foods contain carbs. Today, there are many ways to go about doing this: 1) You can “count carbs.” That’s what I did. From the start, I estimated portion sizes, used on-line sources for carb counts and recorded everything I ate in an Excel chart I created; or 2) You can use an on-line service to do the work for you, but be careful; many of these sources are much too lax in their allowed foods. They think you “can’t” or want to eat in a way that severely limits your carb intake. They’re too friendly to the weak-willed or insufficiently motivated, or 3) Once you know what foods are carbs, you can just totally (or mostly) avoid them, in most meals or by fasting. Whichever way you choose, once you learn about carbs, remember: you just have to stick with Very Low Carb.

I learned what I needed to know, and then I ate (mostly) in compliance with this new knowledge. The foods I ate, were primarily protein and fat – saturated fat that is an inherent component of animal protein. If you aren’t prepared to do that, you will have a tough row to hoe. Artificially manufactured vegetable oil (polyunsaturated) fats are inherently unhealthy, and you must eat fat with protein. Protein has primarily cellular and hormonal functions. And you need healthy saturated fats, and some monounsaturated fats like olive oil, to absorb the fat-soluble vitamins: A, D, E and K.

As I lost weight by eating mostly protein and good fats,, I discovered I needed less food to feel full.  I wasn’t hungry most of the time. My body was in mild ketosis, just ketotic enough to burn body fat as an energy source. Fat and carbs are the only two sources of energy.  I didn’t need to eat carbs for energy. My body fat provided all the energy needed.

That’s when I started to ask myself: If I’m not hungry, why am I eating 3 meals a day? My body runs well on its own fat (and some ketones), so, if I’m not hungry, why eat just because it’s a certain time of day. I started having just coffee with heavy cream for “breakfast,” and skipping lunch or just being sure lunch was only protein with some fat so I could stay mildly ketotic and not be hungry. At supper, just eating a small meal of animal protein (with saturated fat) and a portion of low-carb vegetables tossed in butter or roasted in olive oil, was always enough for me.

But I sometimes snacked. My snacking was always just before supper (happy hour). When I was on anti-diabetes meds (sulfonylureas) that was always the time of day when my blood sugar was lowest. My snacking may be cultural as well. I have always enjoyed a glass of wine, or two. (I only drink spirits in a restaurant or when we have guests for dinner.) And with wine I might have radishes with salt and butter or celery with anchovy paste, or stuffed olives.

My cheats are 1) once in a while I’ll steal some of my wife’s ice cream from the freezer, or 2) in a restaurant, eat a roll with butter or olive oil. Rarely, I’ll share a dessert. These are indulgences. Simple pleasures, from a previous life almost forgotten. The best part of eating Very Low Carb almost all the time, besides the stellar labs, is how well I feel. I am often “pumped,” almost euphoric. The mood difference is palpable. It’s not just knowing I am no longer fat!

Oh, and did I mention...I have saved a lot of money on drugs and food. And my blood pressure is lower. And my HDL doubled and my triglycerides dropped by 2/3rds. And I don’t have to take a statin. And my chronic systemic inflammation blood marker (hsCRP) is way lower. And I did it without exercise (and saved lots of time and gym costs).

And all it requires is that I eat Very Low Carb most of the time. That’s VERY Low Carb. It’s all you have to do.

Retrospective #493: Why fasting is soooo easy!

I know. It doesn’t ring true. It sounds, literally, incredible. But it IS true, as I’ll explain. I wouldn’t lie to you. My credibility with my regular readers is too important for me to squander it.

But first, let’s address the thinking that questions this assertion. On hearing this, a person thinks and maybe asks, “Don’t you get hungry? How’s your energy level? Do you feel okay?” My answers are: “No, I don’t get hungry,” and “my energy level is very high.” In fact, I feel pumped, sometimes euphoric, almost manic. “I actually feel better than okay. I feel great!” And no, I’m not “Tony the Tiger.”

Why then do people ask those questions? Because it’s common sense, and we’ve all experienced it. If you eat less on a “balanced” (carbohydrate-based) diet, you are going t0 be hungry when you don’t eat! And if you don’t “feed your body” (by mouth), your body will slow down! And as your metabolism slows, you will have less energy and you will feel weak. You may even feel unwell. That’s all very logical and true. Yes, but notice the big “if.”

This “if” clause contains the phrase “balanced carb-based diet.” Eating less with that diet will produce the effects described above because you are starving your body of needed energy. It is being starved because it is unable to access your body’s fat stores. However, your body is designed 1) to be fed by mouth when food is available and 2) to be fed from fat stores when food is not available, for example, when fasting. There’s only one problem. For your     body to work like that naturally, a switch is needed to turn on the body’s fat fuel source. Here’s how the switch works.

When you eat carbohydrates, your blood insulin level rises. Your body secretes insulin to carry energy (glucose) from the digested/absorbed carbs in your blood to your cells. Insulin then opens the “door” for the energy to be taken up. Then, when the level of glucose in your blood drops, your insulin level also drops. Insulin is thus the switch. Low insulin signals the liver to switch from burning carbs for energy to burning your body fat stores.

So, in a normal metabolism, when your energy from the carbs you ate and have stored is expended, and your blood glucose level drops, your blood insulin level also drops and your body switches to burning body fat for energy. It does this without your feeling hungry, without slowing down your metabolism, and without making you feel unwell. The reason that all this is true should now be obvious: Your body IS still being fed…FED BY OWN YOUR BODY FAT.

You will be fed at the level your body needs for your activity level. You could run a marathon! This energy balance – called homeostasis – will be met by the liver breaking up triglycerides (body fat) as needed. You will be in energy balance so long as you have fat to burn and you don’t eat too many carbs.

Another way to lower both blood glucose and blood insulin is fasting. It is especially effective for people with a disregulated glucose metabolism, e.g. those with Insulin Resistance (Type 2 diabetics and Pre-diabetics). When we don’t eat, blood glucose and blood insulin go down and good things happen: 1) we burn body fat for energy without slowing down our metabolic rate, 2) we lose weight without hunger because our body is being fed at the cellular level by body fat, 3) ketone bodies, a byproduct of fat (triglyceride) breakdown, feed the brain, and 4) while fasting, out bodies gather up and use cellular debris (autophagy) and 5) oxidize (burn up) old cells (apoptosis). These renewal processes provide great benefit. It is also hypothesized that burning omental (visceral) fat, including fatty liver and pancreatic fat cells, beta cells (erroneously considered to be ”burned out”) begin to function normally again.

I’ve been a Type 2 for diabetic 34 years. So, what happens when I eat Very Low Carb with Intermittent Fasting? I lose weight, my glucose metabolism stabilizes, and I’m never hungry because I’m a fat burner. I have loads of energy, I save money on food (and medicines), and I feel “pumped.” What’s not to like about those outcomes?

Your doctor will love it too. A year ago, my A1c was 5.0%. My cholesterol panel is “to die for.” No statins. “Blood pressure of a teenager,” the nurse said.” When you’re not hungry all the time, fasting really is soooo easy.

Retrospective #492: Weight Maintenance on VLC

As I re-approach (LOL) a 180-pound weight loss and my goal weight of 195 pounds, I’m again giving serious thought to how I am going to maintain that weight. Truth be told, most people who lose a lot don’t maintain it. So, how am I going to do it this time? Ironically, this is a problem I never thought I’d have. Who among the morbidly obese ever achieves their goal weight? Well, after 17 years, and many “misadventures,” I’m nearly there.

Over the years I’ve read lots of bad advice on the subject of “low carb.” Then one day I read something that made sense to me. The advice was in Volek and Phinney’s, The Art and Science of Low Carb Living. A few years later, when I met Stephen Phinney – at Banff in 2016 at the 5^th Global Symposium on Ketogenic Diet Therapies – I told him, “Yours was the first time I had read a prescription for weight maintenance that made sense to me.” He replied, “That’s because we told the truth.” He then added, “Our publisher told us, “If you say that in your book, it won’t sell.” We replied, “We don’t care. It’s the truth.” That’s another reason why it is one of my favorite books.

Excerpt from Chapter 16, “The Importance of Dietary Fat on Long-Term Maintenance,” page 206: “(T)he purpose of this chapter [is] to address the need for added dietary fat while keeping carbohydrates within an acceptable level of tolerance in the long-term maintenance phase of carbohydrate restriction.”  Then, another excerpt from page 210: “There’s no metabolic reason why increasing [protein] would be beneficial,” and “too much protein…has a modest insulin stimulating effect that reduces ketone production.”

From Chapter 18, “10 Clinical Pearls,” page 238, relating to the Induction Phase of Very Low Carb dieting: “the weight loss occurs because you are eating much less energy that your body is burning.” “Typically, early on up to half of your daily energy needs are coming out of your love handles. However, one’s protein needs (expressed as grams per day) are about the same across all phases of carbohydrate restriction, whether it’s your first week in Induction on your second year in weight maintenance.” Then, the coup de grace, this excerpt is from page 239:

“Simply put, there is no option for weight maintenance that is simultaneously low in carbohydrates and low in fat. Your energy has to come from somewhere, and for people with carbohydrate intolerance, their best (and long-term) energy source is dietary fat. Practically speaking, that means purposefully seeking out enjoyable sources of fat and routinely including them in your diet.” “You must get comfortable eating fat as your primary source of dietary energy if you want to succeed in low carb maintenance.” Let that sink in. It’s carbs or fat. It’s pretty clear.

Now that day, for me, is near. I will soon be at my maintenance weight, again. I will then continue to eat the same Very Low Carb way I have striven for over the years. I will still have one cup of coffee at “breakfast” with a dollop of heavy cream and a pinch of pure stevia extract. For lunch, if I eat lunch, I will still eat a small tin of kippered herring snacks in brine, or one or two hard boiled eggs, or a can of Brisling sardines in water or EVOO, or occasionally a Haas avocado with vinaigrette dressing in the cavity. To drink: cold-brew iced tea with liquid stevia.

For supper, I will eat the same small meal of a moderate protein portion and a low-carb vegetable tossed in butter or roasted in olive oil. On occasion, before supper, I will snack on radishes with butter and salt, or celery with anchovy paste, or olives. I will also have two 5-oz. glasses of red wine, usually as a spritzer (topped off with seltzer).

I will continue to weigh myself every day. When I rise to the top of my target range (195-199), I will “fast” for a day. My “fast” will consist of my morning coffee (with cream and stevia) and just one red wine spritzer for supper.

I find that my weight varies more due to water retention, from carb cheats, than from too many calories. Weight lost during a one-day “fast,” due to the diuretic effect, usually returns me to the bottom of my range.

I like what I eat on my VLC diet, and I feel great. I mean pumped! The older and leaner I get, the better I feel! And people tell me I look good in my new wardrobe. It’s actually fun being almost “half the man I once was.”

Retrospective #491: Ketogenic Intermittent Fasting

My wife tells me I should tell “newbies” how I started out on my VERY Low Carb journey, not how I manage to maintain a 180-pound weight loss. I tell her I did that in Type 2 Nutrition #419, Reversing Type 2 Diabetes: My Secrets,” I describe the many ways that my Way of Eating has evolved since I began to eat Very Low Carb in 2002

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In this post, however, I’m writing about my current paradigm, the “Ketogenic Intermittent Fast,” as described by Dominic D’Agostino. D’Agostino, a PhD, is probably the leading researcher in ketogenic metabolism in the USA today. He initiated the 2016 Nutritional Ketosis and Metabolic Therapeutics Conference in Tampa, FL, that I attended. By the 3^rd year, 2019, it had morphed into The Metabolic Health Summit in Long Beach, CA, which I also attended. It sold out, and they announced the next year’s Metabolic Health Summit, would also be held in Long Beach in January. And it was, without me.

D’Agostino appears to be a healthy, very fit, non-diabetic scientist. He says he follows a Ketogenic Intermittent Fasting diet 95% of the time. Jeff Volek, a PhD physiologist, now at Ohio State, is also a world-renowned expert in low carbohydrate research who presented both in Tampa and Long Beach. Together with Stephen Phinney, MD, Volek authored, “The Art and Science of Low Carbohydrate Living,” one of my favorite nutrition books. Phinney is co-founder of  Virta Health, “a clinically proven treatment plan to reverse Type 2 diabetes without medications or surgery.”

At the Tampa meeting Volek spoke to an overflow crowd in a break-out session attended mostly by endurance athletes and bodybuilders. I did not attend. LOL. In Long Beach Volek had a plenary session, which I did attend. But I gleaned from some Tampa attendees that many of the ultra-lean and ultra-muscular attendees take a therapeutic dose of Metformin, off label, to help get and stay lean. Metformin works by 1) suppressing unwanted gluconeogenesis especially in those with any degree of Insulin Resistance, and 2) by increasing insulin sensitivity. In this way users keep their blood glucose levels low and thereby their blood insulin levels low…and thus, being in ketosis, burn body fat (instead of the “unwanted” glucose) for energy TO GET AND STAY LEAN.

This would explain the pied piper interest in Volek and Nutritional Ketosis from athletes and bodybuilders. It stands to reason. To burn body fat, they want to be in nutritional ketosis most of the time. To do that they eat low carb, moderate/high protein, and high fat. They keep blood glucose and blood insulin low, eat protein and exercise to build muscle, and burn body and dietary fat for energy. To get and stay lean, that is their modus operendi.

So, for “healthy” people who want to stay lean, that is the “ketogenic” part. What does that have to do with fasting? When you fast, your blood glucose lowers, you blood insulin lowers, and you burn body fat for energy. If you were a Low Carber before – low enough to be in “Nutritional Ketosis” – your body easily shifts from “fed” to “fasting,” without hunger, and you use body fat for energy and without slowing down your metabolism

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In addition, according to D’Agostino, fasting has 1) anti-inflammatory effects and 2) epigenetic effects, by the mechanisms of apoptosis and autophagy. Check out the hyperlinks. These effects are why ketogenic nutrition and fasting are such hot research topics today. Researchers are exploring the use of ketogenic nutrition and fasting for the whole panoply of metabolic disorders. All that, however, is OT (off topic) for today’s post.

My focus these days is how to maintain my 180-pound weight loss, keep my Type 2 diabetes in remission (with A1c’s in the low 5s), and stay in tip-top physical and mental health. In other words, how I’m going to continue to thrive. I’ve concluded that Ketogenic Intermittent Fasting is the best way for me to do that.

As the National Institutes of Health Richard L. Veech (d. 1/30/20) told Gary Taubes, “Doctors are scared of ketosis. They’re always worried about diabetic ketoacidosis. But ketosis is a normal physiologic state. I would argue that is the normal state of man.” And, as Dr. D’Agostino says, “It keeps the brain happy,” and “I feel better.” D’Agostino also says he “likes the food,” and he’s “lost his sweet tooth.” I like it too.

Retrospective #490: Why, just…why?

I’ve been struggling with this question for a long time. Why what? Well, that’s the problem. It’s hard to figure out what the question is. And then there’s the answer. That’s even more of a conundrum.

As readers know, I’m not afraid to be honest, even brutally honest. I also don’t mind if I offend someone’s sensibilities…if it’s in a good cause. And I believe passionately that the health and well-being of our nation, even the world, both physically and mentally, is a good cause. It’s worth broadcasting the truth, even if at a cost.

I have put the question in various forms: Why don’t people want to change? Why is it so hard for people to change? Can a person change what one eats, or the way, or when, one eats, at any age? Why don’t people believe that changing what they eat will improve their health? Or if they do, whom do they believe when it comes to what is a “healthy diet”? Why should a person give up their favorite “comfort” foods? What if it’s all been a big fat lie?

As I approach column #500, I’m frustrated. I’m no closer to the answer as to why others can’t/don’t/won’t change than I was when I started. I can only re-tell how I did it and hope that is persuasive and connects with you.

In 2002, as I approached the end of my work life, I weighed 375 pounds and faced a short retirement; Why? I looked around and didn’t see many morbidly obese old people, and those I did see didn’t look to be in good health. I had been a diagnosed Type 2 diabetic for 16 years, was maxed out on 2 oral meds and starting a 3^rd. My prospects were that I would soon be injecting insulin. And sooner rather than later I would die of “diabetic complications.”

The common Microvascular ones: 1) end-stage kidney disease with dialysis (nephropathy), 2) being wheelchair bound because of amputation(s) (neuropathy) and 3) blindness (retinopathy). But today, the Macrovascular complications are being recognized as even more common: heart disease, stroke, Alzheimer’s disease (“type 3” diabetes) and several cancers. I was scared. I didn’t want a “short retirement.” I was motivated to change.

My doctor thought the best way to treat my Type 2 diabetes and high blood pressure, was for me to lose weight. He had urged me to do that for many years. All his cajoling – and my attempts – had failed. When I lost weight, following his advice to “eat less and move more,” on a “balanced” diet – I failed. Then, one day, when I walked into his office (at 375 pounds, remember), he said, “Have I got a diet for you!” His timing was perfect.

A few months earlier, in July 2002, my doctor had read, “What If It's All Been a Big Fat Lie,” the cover story of The New York Times Sunday magazine. The author, Gary Taubes, proposed an “Alternate Hypothesis” to the “low-fat,” “balanced” diet that mainstream medicine had pushed for sixty years and has made us fatter and sicker.

Taubes, thrice an award-winning science journalist, wrapped up GC-BC with 10 “certain conclusions [that] seem[ed] inescapable” to him. The first 3 follow; the others are in The Nutrition Debate #5, posted here.

1.      Dietary fat, whether saturated or not, is not the cause of obesity, heart disease, or any other chronic disease of civilization.

2.      The problem is the carbohydrates in the diet, their effect on insulin secretion, and thus the hormonal regulation of homeostasis – the entire harmonic ensemble of the human body. The more easily digestible and refined the carbohydrates, the greater the effect on our health, weight, and well-being.

3.      Sugars – sucrose and high-fructose corn syrup particularly – are especially harmful, because the combination of fructose overburdens the liver which has to dispose of it while glucose simultaneously elevates insulin levels.

My wife says, “Your diet is too extreme. You don’t have to cut out all carbs. You just have to cut down.” Okay, I say, if that works for you, DO IT. I have friends who’ve cut back on their carbs a little and a lot, and they’ve all lost weight. I found it easier to eat so few carbs that my body burned my body fat for energy. I’ve lost 180 pounds. The trick: Eat few enough to lower your blood insulin levels to signal the body to access your body fat. If you don’t access your body fat for fuel, you will be hungry, and you’ll just wind up back where you started.