Monthly Archives: April 2015

Diabetes Should Have It’s Guidelines Changed

Diabetes Turned Upside Down

Reference: Feinman Nutrition 2015

This is it! We have been doing it backwards for 50 years and now is the time to challenge the old treatment method for diabetes and turn to what works. If you or anyone you know has diabetes, send them this article. This review is a challenge to the status quo. It is time to turn our national guidelines on their head. Our health care systems should hear the clarion call and change their education, their dieticians teaching, their handouts, their clinical pathways.

Here is the evidence, as presented in this article. There are 12 points of evidence, as summarized here.

Point 1. Hyperglycemia is the most salient feature of diabetes. Dietary carbohydrate restriction has the greatest effect on decreasing blood glucose levels

Point 2. During the epidemics of obesity and type 2 diabetes, caloric increases have been due almost entirely to increased carbohydrates

Point 3. Benefits of dietary carbohydrate restriction do not require weight loss

Point 4. Although weight loss is not required for benefit, no dietary intervention is better than carbohydrate restriction for weight loss

Point 5. Adherence to low-carbohydrate diets in people with type 2 diabetes is at least as good as adherence to any other dietary interventions and is frequently significantly better.

Point 6. Replacement of carbohydrate with protein is generally beneficial

Point 7. Dietary total and saturated fat do not correlate with risk for cardiovascular disease

Point 8. Plasma saturated fatty acids are controlled by dietary carbohydrate more than by dietary lipids

Point 9. The best predictor of microvascular and, to a lesser extent, macrovascular complications in patients with type 2 diabetes, is glycemic control (HbA1c)

Point 10. Dietary carbohydrate restriction is the most effective method (other than starvation) of reducing serum TGs and increasing high-density lipoprotein

Point 11. Patients with type 2 diabetes on carbohydrate-restricted diets reduce and frequently eliminate medication. People with type 1 usually require lower insulin

Point 12. Intensive glucose lowering by dietary carbohydrate restriction has no side effects comparable to the effects of intensive pharmacologic treatment

“The need for a reappraisal of dietary recommendations stems from the following:

  • General failure to halt the epidemic of diabetes under current guidelines.
  • The specific failure of low-fat diets to improve obesity, cardiovascular risk, or general health (points 1 and 4).
  • Constant reports of side effects of commonly prescribed diabetic medications, some quite serious (points 12
  • Most importantly, the continued success of low-carbohydrate diets to meet the challenges of improvement in the features of diabetes and metabolic syndrome in the absence of side effects.”

WWW.   What will work for me. I’ve followed a high fat, low carb diet for four months and lowered my own borderline high sugar from 102 to 73. I lost 25 pounds.   I raised my HDLs to 61 from 28.   It was so simple. And I didn’t feel hungry. If your doctor tells you to follow a low fat diet, leave him/her and follow your own common sense.   Read this article, word for word and save your own life. It’s going to take 10 years for health care to get its act together and change.

Pop Quiz

  1. Current guidelines from the American Heart Association and American Diabetes Association advocate control of diabetes through the use of a low fat diet. T or F

True

  1. This has resulted in good control of Americans’ diabetes. T or F

Patently false

  1. We, as a nation, have made an enormous health care blunder. T or F

True

  1. It’s time to make a radical shift and change our approach. T or F

As fast as possible

  1. If you have a blood sugar above 90, you will serve yourself and your health better by eating eggs and bacon for breakfast instead of oatmeal? T or F

True.

 

What’s the Right Dose of Exercise: AKA – The Hiking Club has it Right

What’s the Right Dose of Exercise?   AKA: The Hiking Club Has it Right

Reference:   New York Times, JAMA Internal Medicine April 2015 J Am Coll Cardiogy Feb 2015 Annals of Inter Med Jan 2015 Harvard JAMA Internal Med

“A day without exercise is as bad as a day of smoking!”   Ever heard that?   Tim Cook called it “the new cancer”.   Being a couch potato is risky.   So tempting, but risky.   But how risky?   It’s so lovely and convenient to veg out and watch TV and be lazy.   To act differently, I need to know the benefit. What is the benefit? This is the research.

The data.   Follow 204,542 Australians, ages 45-75 followed for 9 years for death rate, while getting precise data on amount and type of exercise – that’s the data base.   That is 1,444,927 person years of mortality data in the study. That big a study has credibility.   There were 7,435 deaths in that time range, again a big number.   The second study from Harvard followed 661,137 people with 116,686 deaths from ages 21-98.   Again, pretty credible.

Most health organizations and the government recommend you get about 150 minutes a week of moderate exercise.   Against that backdrop, these two major studies compared the mortality of non exercisers, those who met the guidelines, those who exceeded them a little and those who exceeded them a lot.   If you exercise a little, but don’t meet the 150 minutes guideline, you reduce your risks of death about 20%. Those who exercise the full recommended 120 minutes a week reduced their mortality by 31%.    Wow.

That’s a lot. But it’s not the best! Those who exceeded the recommended exercise by triple or 450 minutes a week (little over an hour a day) reduced their mortality by 39%.   And finally, those few who exercise more, up to 10 times more, didn’t get any more benefit, and in fact declined back to the level of those meeting guidelines.   So, the sweet spot is an hour a day.   The Australian study adds a bit more by looking at intensity of exercise. For those who got sweaty less than 30% of their exercise time over those who were just walking got an additional 9% of benefit. If they got sweaty for over 30% of their time, they got a 13% extra benefit.

If you want to get sweaty, what about jogging?   A third study called the Copenhagen Study looked at the optimal benefit obtained from jogging. They found a U shaped curve that showed maximum benefit from light and moderate jogging, meaning 1.0-2.4 hours a week of jogging was best, with as much as a 78% reduction in mortality for slower running, not too often (2-3 times a week).   Strenuous joggers had no benefit over non-jogging.   (Did you get that? NO benefit.)

And compared to being sedentary?   The study in Annals shows that prolonged sitting is its own risk, all by itself.   And prolonged sitting of 8 hours a day essentially erases the benefit of daily exercise.   So walking an hour, then sitting 8 hours ends up with no benefit.

That makes your elevator quote: “An hour a day keeps the doctor away, as long as you don’t sit for 8 hours. “

WWW. What will work for me.   It looks like the Wisconsin Hiking Club has it right.   They organize 4-6 mile hikes 5 times a week allowing you to walk two-three times a week, get your seven hours of walking in while having the company of friends and community encouragement. I’m a member and closing in on my 1,000 mile award. Add that to my dog walking, my evening strolls and an occasional morning run, and I’m close to making the perfect formula to optimal health and longevity. Exercise is something magic. If I could just find a way to do some heavy lifting, and stop sitting so much at work.   But then I would be insufferably self-righteous.   But you, my friends and readers are welcome to join us in the Hiking Club. We’re essentially free and have visitors on almost every hike. Just be at the destination listed on line 10 minutes early because we leave on time.

 

Pop Quiz

  1. Being a couch potato is dangerous, in and of itself?   T or F

Deadly.

  1. The recommended weekly exercise of 150 minutes is the best formula for health and longevity. T or F

False.   It’s only a third – but don’t get me wrong. It’s wonderful for you. But best is an hour a day of walking.

  1. Getting sweaty for 30% of the time is better than just casual walking?   T or F

True

  1. If I run daily, I should run slowly, three times a week. T or F

That seems to be the best.

  1. Running an hour a day is better than 20 minutes, twice a week.

False, it’s as bad as not running at all

  1. Hiking can be free! T or F

True.   Join Us!

How to Raise Your HDLs and Lower your Heart Disease Risk

High HDLs and Risk of Heart Disease

Reference:   Wilkins JAHA 2014

We hear all this stuff about LDLs and statins, but no one ever talks about HDLs and how protective they are.   They are protective.   Ostensibly their duty is to scour around and pick up extra fatty acids that they can bring back to the liver for processing.   Small, dense HDLs are just as problematic is small, dense LDLs. You want to have big, fluffy HDLs just like you want to have big, fluffy LDLs.   Now, that’s the traditional medical interpretation of HDLs.   It markedly underestimates their role and their value. You want higher HDLs. It should be one of your health goals.

What this study shows is an elegant demonstration of the inverse relationship between heart disease risk and HDLs.   Following 11,515 men and 12,925 women for 307,245 people years of follow-up, the researchers were able to show that HDLs inversely correlated with heart disease risk. The higher your HDLs, the less heart disease risk you have. The lower your HDL, the deeper you are in doo-doo. Look at the graphs in the article (it’s open access) and you will see the decrease in heart disease risk in both men and women as you increase your HDLs. Men keep decreasing risk up to about 90 HDLs, and women up to about 75.   That’s great!

Eric Westman, of Duke University, and one of America’s leading weight loss experts uses HDLs in his weight loss clinic.   If someone’s HDLs are rising, they are losing weight and on track. We’ve known this phenomenon for years. But if you look over the studies in the literature, it has been masked and hard to see the pattern because most of the diets for weight loss are low fat. Eric Westman claims that when HDLs stop rising, he investigates precise dietary diaries and usually finds someone has started eating more carbohydrates, usually in the form of nuts.   The client thought nuts were basically all fat, but in fact have enough carbs to sabatoge both their weight loss and their HDLs rising.   After a year of dieting on a low carb diet, Westman claims that many will achieve HDLs of 100 – thereby reaching a peak of cardiovascular risk reduction.   Hmmm. That’s the opposite of what the American Heart says.

Ok, explain a simpler theory.   Here is mine. I believe that LDLs are simply transport tools in your body taking fats manufactured in your liver out to fat cells to be stored.   HDLs are their remnant and essentially reflect unused LDLs.   In the world of modern analogies, I call LDLs full 18 wheelers taking manufactured inventory from the factory (your liver) to the warehouse (your fat cell).   HDLs are empty 18 wheelers, sitting in the parking lot waiting for the dispatcher to give them something to do.   Throughout all of human history, we had carbs only seasonally at the end of the growing season, when we gorged on them, put on weight and had a seasonal rise in our LDLs. The rest of the year, we ate fat and protein, lost weight and had our HDLs climb.   HDLs will climb when you are on a high fat, low carb diet.   They will keep climbing as you lose weight and progressively decrease the biological demand for LDLs to transport fats.   You want more HDLs and a lower Total Cholesterol/HDL ratio. The Quebec Study proves that. The Lower your TC/HDL ratio, the lower your risk for heart disease.

WWW. What will work for me.   Ok, I was intruiged with this data. I’ve spent my entire career trying to raise my own miserable HDLs of 28. My father had heart disease and was diabetic. With running 2 miles a day and taking 1000 mg of Niacin (until my face flushed bright red) – the two recommendations to raise your HDL from American Heart), I got my own HDLs all the way up to 32.   Whoop dee doo! Now, since January 1 I have averaged a 70% fat, under 15% carb diet. I have lost 25 pounds and my HDLS just got in. I hit 61 in just 3 months. My LDLs didn’t fall but my ratio is now under 3, for the first time EVER.   If this was just me, I would keep private. But I’ve demonstrated this same phenomenon on dozens of folks willing to stick with it and get measured twice. In fact, it has worked on everyone so far.   Must be something to it.   Your enemy is not fat, it’s extra carbs. If you have high LDLs, it simply means you have overwhelmed the ability of your body to burn and process them, so your liver is turning them into fat and your body is transporting that fat to your fat cells. (No ifs, ands or butts!).

 

Pop Quiz

  1. High HDLs should be one of my health goals.   T or F

Yup

  1. The only way to reliably get high HDLs is to eat fat, stop eating carbs. T or F

Trick question.   It’s not the only way.   Getting yourself born into the right family helps. Good genes are useful. But diet can do it for those of us with lousy genes.

  1. I can change my lousy HDLS in three months more effectively than with a statin. T or F

Slam dunk true

  1. There is more money in statins than in effective weight loss and that has a huge effect on public policy. T or F

You guess

  1. Losing weight and eating differently is more effective than taking pills.

Four to one.

 

 

Ketones – Your Weight Loss Friend

Ketones: 101

Reference: Do Ketogenic Diets Really Suppress Appetite?

When you lose weight, you want to lose it from fat, right? When you are losing weight from fat the broken down pieces of the fat are called ketones.   They are typically about 4 carbons long and the most common one is called beta-hydroxybutyrate. So, why does your doctor freak out when you talk about wanting to have ketones? That’s because most of us were trained in the era of understanding dangerous diabetes in the hospital, not weight loss in the home. When diabetics are completely out of control and their insulin has disappeared, their bodies grab fat to try and get energy and they swirl up into more and more ketone burning, which they can’t turn off.   So, ketosis is dangerous for insulin dependent diabetics.   Big deal for first year medical students, studying physiology in the hospital.

For the rest of us trying to lose weight, it is desired.   We have two buckets of energy in our bodies. Our carbohydrate bucket is about 1500 calories big (its called glycogen) and as long as we eat some carbs three times a day, we will keep that bucket full. We will also be secreting insulin to help store those carbs. And that insulin will keep your fat cells shut tight. Hence, ANY DIET that has even modest carbs in it three times a day, will never ever, ever, ever lose weight from fat, because insulin will seal fat cells shut. And you are living off of that 1500 calorie bucket. Your fat bucket is much bigger. Most women are 33% fat, which comes down to 150,000-300,000 calorie buckets.   To lose weight from fat, you must have ketones in your blood.

The first step to achieving that is to accommodate your brain to ketones and transition your body from running on carbs to running on ketones.   Your brain actually thrives on ketones.   Some gurus have made a living off that concept.   That’s the trick, getting your brain to feel happy with ketones. The switch from carbs to ketones takes some 5-7 days, though we don’t have good human studies. We do have studies in rats fed precisely measured low carb, high fat diets.   The higher the fat content compared to protein resulted in the least weight gain compared to rats fed high carb rat chow.   In us humans, the evidence appears to be accumulating that we need to be modest in the amount of protein we eat too. To lose weight, we have to induce ketosis, and that happens best when we eat more fat than protein, and less then 20 grams a day of carbs.

So, put it all together. Ketones are what your body naturally makes when you eat fat, and when you are losing weight from fat. Ketones are what our bodies lived off of every winter in most of human history.   (Either fatty animals we hunted or our own fat stores.) In the modern era, to lose weight from fat means we must eat like we used to in winter, a millennia ago – BC (Before Carbs or Before Civilization). You don’t need to be afraid of ketones, you should embrace them as the intentional process of controlling your weight.

WWW. What will work for me. I believe humans have had ketogenic diets every year for 6 months as long as we have been humans. It is only with civilization and the storing of carbs to have year around that we got away from eating fat, with a bit of protein.   When I eat fat, I don’t get as hungry as I do when I eat carbs. Try if for yourself

Pop Quiz

  1. To lose weight from fat, you must eat fat. T or F

True

  1. Rat studies show that we have the least weight gain when we eat the most fat.   T or F

True

  1. Many doctors are afraid of ketones because they were trained to be wary of ketosis in diabetics, where it is dangerous. T or F

True

  1. If you were told that the Institute of Medicine recommended that we eat 150 grams a day of carbohydrates, you could assume that was not a weight loss diet. T or F

Again, true.

  1. America keeps getting fatter, probably because we are eating even more than 150 grams of carbs a day. True or false.

You are on a streak – true

  1. The Atkins diet is a low fat diet.   T or F

False. It’s a low carb (20 grams) and modest protein (< 25%) diet.