The Arrow #105
Greetings from Dallas.
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Couple of things…
First, I got an email from a reader taking me to task for incorrectly calculating the proper dose of Yacon syrup for weight loss as per my post a couple of weeks ago. The reader had recalculated and discovered that my calculations came up with a dose that was way too high. High enough, she wrote, that it equaled the larger dose in the study that gave those subjects on that higher dose GI effects troublesome enough that they discontinued the program.
I didn’t think I could be that far off, so I rechecked my calculations, and I had indeed made a mistake. For some reason, I used 4 grams as the weight of a teaspoon of syrup instead of the 5 grams I had intended. I’ve got 4 grams on the brain because of the talk I’m putting together for Boca Raton in a bit over a week. I’ll be discussing calories, and carbohydrates contain 4 kcal per gram. A teaspoon of sugar weighs in at 5 grams, which is the number I meant to use.
The Yacon syrup the researchers in the article used contained 41 percent FOS, which they assumed was the active ingredient. When I did my own looking around, I noticed that different sources had the FOS content of Yacon syrup as being anywhere from 40 percent to 50 percent. When I cobbled all this info together, I came up with a dose that was a little high as compared to the 0.14 g/kg used in the study.
I tried to find the weight of Yacon syrup online, but failed to do so. Since it has much the same consistency as molasses, I used that as a stand in. Molasses turns out to weigh 5.83 g per teaspoon. Using this figure, I recalculated (several times) and came out with a dosage of 4 tsp per day for a 150 pound person. This calculates to a little over 1/4 tsp per each 10 pounds of body weight. And that’s calculated using the 41 percent FOS figure used in the study. So, if your particular brand of Yacon syrup contains more FOS, then you would have to lower the dose a bit.
The referenced study used two doses of the syrup. The lower dose was 0.14 g FOS per kg body weight; the other was double that at 0.28 g FOS per kg body weight. Half of the subjects in the study group got the 0.14 g dose, while the other half got the 0.28 g dose. As the study progressed, those on the 0.28 dose developed multiple GI symptoms whereas those on the 0.14 dose did not. Since those on the higher dose had such problems, causing some to drop out, their results were not included in the study.
What this tells me is that the optimum dose—the dose producing the greatest results with the fewest side effects—is somewhere between 0.14 g and 0.28 g. Where that optimum point is, we don’t know precisely. It’s possible the optimal dose is the 0.14 g that the researchers hit on by luck, but I kind of doubt it.
If you’re giving this a try, you might want to start at the 1/4 tsp per each ten pounds of body weight and move up a little from there until you develop symptoms, then move back down a bit. But the excellent results of this study were in those using the 0.14 g (or 1/4 tsp per each 10 pounds of body weight).
If you are using the 1/4 tsp/10 lb dose and you develop symptoms, you may have a brand of Yacon syrup that contains more than the 41 percent FOS used for the calculations. If you do have symptoms, back off a bit till they go away, then stick with whatever dose you end up with.
My reader did tell me she started with the dose I recommended (which is higher than it should be) and had some GI symptoms. But she continued taking it and the symptoms pretty much resolved. Which tells me the body may have to do a little accommodating to the FOS.
Second, in a week or two, I’m going to be starting a paid subscription to The Arrow. Some, but not all, content will continue to be free. I’m doing this for a handful of reasons.
Before I would even think of charging for a subscription, I wanted to prove to myself that I could stick with it and come up with content week after week. Well, it’s just passed two years now, and I haven’t missed a week. Even when I got Covid. It was an abbreviated issue, but it still went out. Having said that, this issue and the next may be abbreviated, because I’m putting together my talk for the conference in Boca Raton, and, as usual, I’m behind in doing so.
I put in a huge amount of time on creating this newsletter. It’s not just the time I put in writing it, but the time I put in trying to figure out what to write and researching and studying that stuff. If I’m ever going to get Protein Power 2.0 finished (which is one of my New Year’s resolutions for 2023), I’ve got to spend some serious time working on it. Which time right now is taken up by The Arrow. If I write both The Arrow and PP 2.0, then I’ll have a real job, not just a hobby. And people get paid for real jobs.
Once I ended up with a contact at Substack, they’ve been great. Very responsive. They’ve helped me out a bunch. And the only way they get paid is if I get paid. Since I’ve paid for my former email hosting service and for virtually everything else I’ve ever done online, I hate to feel like I’m taking advantage of Substack.
I’ve had numerous people contact me asking if they can get old editions of The Arrow. With my old provider, I couldn’t make that happen without going in and retrieving individual copies to email to those who asked for them. I couldn’t figure out how to make them all public.
When I bolted from ConvertKit (my old provider) to Substack, I had to pay someone to go in and move the content out. It was a real task, but ConvertKit helped make it happen despite knowing they would probably lose me as a client. My tech guy was most impressed with all their effort. Along with being a tech guy, he is a long-time blogger about tech issues and blogging. He wrote a piece on his great experience with ConvertKit in moving my files. In this tale, I am the client.
Now that I have all the old issues of The Arrow, going all the way back to when it was the No Name Newsletter. I have to get them tweaked a bit, then they’ll be ready to read. I’m going to offer access to them as an inducement for those who sign up for an annual subscription. From issue #97 on, all are now on Substack and available for viewing any time.
It’s been interesting to me to observe what has happened since I started writing The Arrow weekly. I started out with a mailing list of people who had signed up to get notices of new blog posts. Almost all of my blog posts revolved around low-carb dieting in one way or another. So, most of those subscribers were interested in low-carb.
When I first emailed my list in late 2020 asking if there would be interest in a weekly “eclectic” newsletter, I got an overwhelming number of emails saying YES. I don’t recall anyone telling me not to do it.
Then when I sent out the first edition of what would become The Arrow, I had an enormous number of people unsubscribe. Same over the following weeks. Soon I realized (or at least I believed) I had fallen victim to exactly what Paul Graham tweeted about not too long ago.
I am at the core a pretty skeptical person. It takes a fair amount of evidence before I’ll take a strong stand on something. It was not so in my callow youth when I fell victim of the idiocy proclaimed by Stanford biologist and professor Paul Ehrlich’s overpopulation fear mongering. He came to speak at my engineering school, and I was mesmerized. I read and reread his book The Population Bomb and recommended it to everyone. He was to appear on the Johnny Carson Show, and I badgered my poor parents into watching it. My father’s response was, What a crock of shit! I was in disbelief that anyone could not see the light given all the data he presented. I wrote it off as my father being a total philistine. No one other than such could doubt the great Paul Ehrlich. I traveled to other schools persuading friends to go with me to see him talk. I was completely enthralled. I bought it all hook, line, and sinker.
Then it never came to pass. And Ehrlich lost a major bet on it with Julian Simon and had to pay up. Which he did quietly. And over the years, I watched him be wrong on virtually everything. He basically took my lack-of-skepticism virginity, and I’ve never been the same since. All I’ve got to do is remember how wound up I was in believing in and proselytizing on behalf of Ehrlich to make me scornful of all doomsdayers. And skeptical of almost all claims until proven to my satisfaction.
I lived through the Ehrlich debacle and read extensively on another doomsday scenario from the early 20th century that was much more likely to cause widespread devastation and starvation than what Ehrlich had predicted. It was the population bomb of its time. And was completely solved by human ingenuity.
I wrote about it at length here, but in short, the world’s population was growing at the same time natural fertilizers were running short. The air we breathe is 78-79 percent percent nitrogen. Plants need nitrogen to grow, but they can’t pull it from the air. It has to be “fixed” in the ground in which they grow for the plants to extract it. Which is why farmers had to rotate crops before the advent of fertilizers. They would grow their crops on one plot of land while growing certain plants on the fallow lands to help fix nitrogen. Just like Ehrlich projected his population growth figures, they did the same in the early 1900s and realized they would soon run out of arable land, especially if the natural fertilizers ran out. With what they considered the rapid population growth at the time, they could see grim times in the near future in terms of being able to feed people.
Then a scientist named Fritz Haber figured out how to build a contraption that could convert the nitrogen in the air into ammonia, which is basically fertilizer. But then everyone said, Hey, that’s great Fritz, but with the pressures and all the rest required to make your little device work, it can never be made commercially. Then came Carl Bosch, a German chemist and industrial engineer whose company funded him to try to make it work. It took a while, but Bosch persevered and ultimately made it all happen. Now there are Haber-Bosch plants all over the world cranking out all the fertilizer we’ll ever need.
Same with Thomas Edison. It took him forever—200, 300 tries—to make a lightbulb that worked. But once he figured out how to do it, it was no time till they were being cranked out by the thousands and lighting the world.
This is why I’m excited with the whole fusion process for the creation of energy. It’s taken a long time, but finally the folks at the Lawrence Livermore lab made it work. They got considerably more energy out than they had to put into the process.
Fusion is great because the fuel is much simpler than the fuel used in existing nuclear power plants. It’s much, much less likely to lead to runaway chain reaction meltdowns. And it doesn’t produce radioactive waste as a by-product that has to be dealt with.
The great thing is that they finally made it work. Now it’s just a matter of figuring out how to make it commercial. The first step, the Haber step of making it work on a small scale, is the toughest. Once that’s been accomplished, it seems not to take long to make it in industrial quantities. Think Tesla. Elon Musk and team figured out how to make a great electric car, while all the other car companies said there were too many problems. Now every manufacturer is making EVs.
The one thing I’m not skeptical about is human ingenuity.
Back to the many people who unsubscribed from this newsletter early. A number of them emailed me telling me a la Graham above that they could no longer believe in anything I might have to say about nutrition because I hadn’t accepted climate change as The Science.
Then the same thing happened when I became wary of the vaccines. As I wrote about early on, everything The Science was saying about the Covid virus and the vaccine was not in accordance with what I learned in medical school. But since medical school was a long way back in my rear view mirror, I figured maybe things had changed. I ordered a brand new immunology review book published in 2019. (There is a newer edition out now that I have on order but the 2019 edition was the most recent I could find at the time. I read it cover to cover. It confirmed everything I remembered from medical school. Some of the stuff I learned back in the day was speculative at that time. Now it had been confirmed. No real surprises, just more technical updates. The new immunology book in many ways countered The Science. I chose to go with the book.
At that time, early on in the Covid pandemic, I watched an interview with Knut Wittkowski, a German epidemiologist who had worked for 15 years with world-famous German epidemiologist Klaus Dietz, had also worked for the CDC, and for the past 20 years had been the head of the head of the department of biostatistics, epidemiology and research design at The Rockefeller University in New York. The interview was on YouTube, but was removed in fairly short order.
What Wittkowski had to say meshed nicely with what I had just read in my new immunology book. He was in NY at the time, so was at Ground Zero, so to speak, of all the craziness going on there. In the interview, he was asked his advice. He said the schools should stay open as kids aren’t much affected by the Covid virus. They would become a big part of the herd immunity that would get us through it. He said businesses should stay open and that the elderly with co-morbidities should be protected. At the time, there was no vaccine on the horizon, so he didn’t comment on that other than by saying there was no chance of getting a vaccine in time to prevent the spread, so our best bet was herd immunity.
Turns out he was correct.
The problem in NYC was that the docs didn’t listen to those who were promoting early treatment. They were demanding more and more ventilators, which really did nothing but kill people. And Cuomo sent people with Covid back to nursing homes to open up beds in regular hospitals, which, of course, led to many, many deaths of elderly people. He did that for what I believe were political reasons.
Donald Trump, who is from New York, sent the hospital ship USS Comfort to take the overflow that everyone seemed to be talking about on TV. He also funded the conversion of the Javitz Center into a temporary hospital with about 2,000 beds, and both pretty much went unused. Mount Sinai hospital also created a tent hospital in Central Park that went begging. Instead, the hew and cry was that the hospital system was going to be overrun with Covid patients dying right and left, so the only alternative was to lockdown to “flatten the curve.”
Wittkowski was absolutely correct in virtually everything he recommended. When I wrote about it, once again, I had a ton of unsubscribers who apparently thought if I wasn’t all in on the lockdowns and school closings, then I wasn’t worth listening to about anything.
Next thing to come along were the vaccines. You can only imagine the grief I got over those in the emails of former subscribers.
I figured I was providing a perspective from a physician who had been in the primary care trenches for years, and who had a nutritional background. I didn’t stand to make or lose any money due to my perspective on the vaccines, Covid, politics, etc. I was just basically telling it as I saw it, not filtered through a political or media bias.
What I’m leading up to with all this is that I would like to find out what everyone wants to read about in The Arrow. Fortunately, unlike ConvertKit, Substack provides a way to do polls without having to add a paid-for third party app. Unfortunately, it doesn’t give me the ability to put up a bunch of choices and let folks pick the ones they want. Which then I can tabulate and find out what everyone wants to read about.
I’ll have to use several polls, all of which have only one choice.
So, here goes.
I don’t know if these polls are the kind where you see the results after you vote or not. As I’ve never done one, I’m flying blind here. If you can’t see them, I’ll post them next week.
The Damar Hamlin Situation
For those of you who live outside the US and may not know, Damar Hamlin is a 24 year old professional football player who had a cardiac arrest during the Monday night football game a few days ago. It happened on national TV in front of tens of millions of viewers, and even more have seen it since.
Strangely, the only clip I could find on YouTube is in Arabic, but it’s the best one. And has subtitles.
We’ve all seen our share of young athletes collapsing this year. This is the first one of an American professional football player, however. And it happened on live television on Monday Night Football. Again, for those of you who don’t live here, the game was canceled and postponed, which is the first time I’ve ever seen that happen in professional sports in the US.
The young man was defibrillated on the field, resuscitated, and taken to the University medial center. There are reports he had to be defibrillated again in the hospital, and other reports saying those first reports were inaccurate. So, I don’t know the full story on that.
Strangely enough, right in the middle of writing this, MD got an alert on her phone that he had regained consciousness. And that his first question was, Who won the game? Here is the USA Today story on it I just pulled down.
Immediately after Hamlin collapsed, Twitter lit up with those saying it was a vaccine-induced issue and other saying it wasn’t.
The truth is, at this point no one knows. There are very few issues that would cause a 24 year old man in perfect physical condition to have a heart attack. I was called as an expert witness years ago in a case involving a man in Little Rock who had a heart attack in the doctor’s office at age 30, and everyone thought that was unheard of. And the victim in that case was certainly not in Damar Hamlin’s physical condition.
I read recently that there are about 15 football deaths in the US each year. Most of them in high school football, which makes sense as there are many more young men playing high school football than there are playing college football. And vastly more in college than there are playing professional football.
Athletes who climb the ladder to college then the pros go through much more exhaustive physicals than do the kids who sign up to play high school football. Most of them get a note from their family doctor saying they’re fit to play. Some get kind of Mickey Mouse sports physicals. I’ve done many, many of those. You listen to the kid’s chest, check out his eyes, nose, throat, and ears. Check for a hernia. Check his blood pressure. And that’s about it. Other than listening closely for a heart murmur, which can be the marker of a potential problem, it’s almost worthless.
The pros go through a vastly more comprehensive physical. They are valuable commodities, so the teams hiring them want to make sure they’re fit to play and won’t have some sort of issue that sidelines them permanently while the team still has to pay them.
Which is why you don’t see this happen more often. They are thoroughly vetted from a health perspective.
We can be fairly sure Hamlin was vaccinated, because the NFL has a vaccine mandate. But he may have applied for a religious exemption or something. Since there have been so many vaccine-related injuries to young men (and women), I think his vaccination status is pertinent.
But I’m not ready to call it a vaccine injury at this point, because we simply don’t know. I am happy he is awake and apparently aware of what’s going on. Let’s not jump to any conclusions until we know more. Right now it’s only a guess.
The GOP Speaker of the House Drama
One of the things I’m really grateful for is Rumble and the other upstart video sites that allow free speech. One of my favorite shows is System Update, which is hosted on Rumble by Glen Greenwald. I used to really dislike Greenwald, but now it’s just the opposite. I don’t know if he came around to my way of thinking, or if I came around to his, but most of the time I find we’re on pretty much the same wavelength.
Here is a recent System Update I enjoyed immensely. (The show doesn’t start till the 9:00 mark, so fast forward to that.) One of the complaints I have with Substack—one I’ve discussed with them and was told they were looking into it—is that all I have to do to embed a Tweet or a YouTube is copy it and past it in The Arrow, and, Bingo, there it is. With Rumble videos, I can only provide a link.
Greenwald’s monologue was about the in fighting and multiple votes taking place for speaker of the house. Here are some excerpts:
On this show, and in my journalism generally, we rarely talk about politics through the prism of the two political parties. That's true for so many reasons, starting with the fact that the establishment wings of each party have so much more in common than they do differences that anyone who sees the world through a primarily partisan lens is destined to wander very far astray, very quickly, from the dynamics and insights that truly matter.
That's the cable news way of seeing the world for a good reason: it's far more obfuscating than illuminating. The Democrat v. Republican theater is designed to hide and distract your attention away from the real power dynamic in Washington, where both parties are generally on board.
But on last night's show, we decided to make an exception. That's because there is one difference between the parties right now worth acknowledging. Democrats — from their so-called right-wing and centrists to their so-called left-wing and everything in between — have become extremely adept at marching in lockstep, following the decrees of their Party leaders, liberating themselves of any internal dissent, and uniting as one hive-minded herd of like-minded consensus.
Why the hive-minded herd of like-minded consensus? You guessed it. The election of the Dem’s and the neo-con’s favorite bête noire The Donald.
The left, of course, thinks of Trump as a fascist or, even worse, a Nazi. And, as Greenwald points out
…if you really believe that you're now in a historic battle to vanquish the new Hitler and his Nazi party I suppose it makes sense that you would reject any attempts to argue amongst yourselves or defy orders from the army you imagine yourself part of. Though I also think it has much to do with the modern-day, laughable mentality in the U.S., it has become an authoritarian movement in terms of what it believes and supports — a union of state and corporate power to censor the Internet, a belief that the CIA, FBI and Homeland Security are benevolent institutions and eager to use American political power to interfere in multiple countries around the world, based on the neocon fairy tale that the U.S. Foreign Policy Community seeks to spread democracy and human rights and vanquish tyranny — and authoritarianism at its core disdains disorder and defiance and venerates instead subservience to one's leaders.
Although they love to think of themselves in the exact opposite vein — as sophisticates who are far too intelligent and intellectual and educated and individualistic to be led like some cult — that's exactly what they have become. Democratic politicians, including those who branded themselves anti-establishment, left-wing radicals, and dissidents — not only do what they're told with remarkably unyielding obedience, but they seem to take pride in this fact as if it's an accomplishment to be celebrated. They're proud of their subservience and of their relinquishment and submission of any individual thoughts at the altar of the will of their leaders. The Democratic Party is a well-oiled machine whose primary characteristic is that its members think exactly alike and do what and think what they're told.
Before I started reading mystery and detective novels for pleasure, I read every spy novel I could get my hands on. And I had visions of writing my own spy novel…until I switched over to mysteries. But I followed a number of ex-CIA and ex-NSA writers on Twitter. They all went over the edge when Trump got elected, and when he appointed General Michael Flynn as his National Security Advisor, they went completely ballistic. I couldn’t figure out why they disliked Flynn so much, but, as it turned out, he had big plans to audit and attempt to overhaul the entire intelligence community.
Consequently, he was set up by Comey and the FBI, which ended his career after only a few weeks. Had I known the deep-seated hatred the entire security apparatus had for Trump, I would have been less surprised. In my view, they are totally out of hand, as has been evidenced by their immersion in and direction of Twitter to remove tweets they don’t like. Twitter is just the only one we know about for sure. I’m sure they are just as embedded in the NY Times, CNN, and countless other legacy media companies.
Most of these House Republicans are not obeying party dictates but are doing the opposite, defying party leadership to stay true to the values their voters sent them to Washington to defend. But amazingly, when House Democrats look at all of this, they do not see an impressive display of independence or of will or defiance of party leadership. What they see, seemingly all of them, including the vaunted Squad who got elected by promising to aggressively challenge and subvert Democratic Party leadership — what they look at and see is an embarrassing mess, some disorderly refusal to submit to authority, and a kind of distasteful and gauche failure to snap into line and march in lockstep behind party bosses as they so willingly and successfully do.
House Democrats spent the day today openly mocking Republicans for what they apparently regard as their shameful internal divisions. One of the most embarrassing displays came, unsurprisingly, from New York Democrat and Squad member Jamaal Bowman. On his Twitter feed, he posed self-consciously with other members of the far more orderly and obedient Democratic caucus as they all sat ingrained in apparent pride over how they, unlike these conservative ruffians, did what they were told to do without making any fuss when choosing their leader. Bowman proudly exclaimed: “Kevin McCarthy doesn't have the votes. We're in a good mood”.
Why? At some point, the House Republicans will use their slim majority to elect a Republican, not a Democrat, who ends up as Speaker. Do Americans really care? Will they even remember by next week if they take note at all that it took a few ballots or a couple of days for the House Republicans to decide on the Speaker? The reason Bowman is grinning with such pride seems very obvious at this point. Like all authoritarians, he and his Democratic colleagues venerate order and subservience to leaders as the highest value to him.
Watching a couple of dozen Congress members wrangle for power and leverage is a source of shame because it is the result of what he regards as an irreverent and insubordinate refusal to snap into line and command an attribute he evidently regards as noble. And the reason I know that he thinks this way isn't just because of this cloying grin he donned today. It's because the politics he and his fellow Squad members practice, is driven by little other than subservience to Party leaders, and obsequiously falling into line behind those leaders, even when doing so is a complete negation of everything they claim to believe in.
Greenwald goes on to discuss The Squad, all of whom got elected to fight against the mainstream Democrats, whom they said had sold out their constituents to the big lobbyists. Now they march in lockstep with the rest of the party and don’t make a peep.
I hope Democrats have fun today, as they watch actual politicians across the aisle do what real politicians do and ought to do -- use one of the very few times they have real leverage to extract concessions in defiance of party leaders in order to get what they want, rather than fall meekly, obediently into line behind them and do what they're told without a peep of protest or dissent. The examples of the Squad completely abandoning their own professed values in order to advance the only thing they really seem to believe in -- servitude to partisan demands -- is far too long to list tonight, especially when we have such an esteemed and important guest waiting for us to talk to. We don't want to keep him waiting. We've covered these episodes all before in-depth, many times, as unpleasant and cringe-inducing as that work is. Watching these gruesome, borderline pornographic scenes of submission by the Squad to Nancy Pelosi and the Biden White House is a sacrifice we make for journalism. Journalism always must come first.
So, the disorder and fleeting internal divisions in the House Republican caucus over the speaker may be disruptive, but given the nature of Washington politics, I far prefer disruption to the meek obedience and orderly submission, often by Democratic House members, including especially these self-branded, anti-establishment, radical members of the Squad.
Watch the entire monologue if you have the time. It’s great.
Big Food Is Selling Out Our Kids
Tucker Carlson had on his show last night a guy who was an inside operative for Coca Cola and then turned whistleblower. If this is true, it is a travesty. Remember the Paul Graham essay I posted a few weeks ago about the submarine? This is the submarine at its worst. It’s difficult to believe any company would go to these lengths to smear a competitor. But… Sorry I don’t have the YouTube version as it doesn’t exist yet. You’ll have to watch it on this Fox News link, which is less than optimal. If it appears on YouTube in the next few days, I’ll stick it up here.
Pounds Lost & Pounds Saved on a Low-Carb Diet
A great new study just crossed my desk showing the efficacy of a low-carb diet in treating diabetics and pre-diabetics in a busy general medical practice. I love these kinds of studies that are not randomized, controlled trials, but are simply studies done with a group of patients in a doctor’s office.
Randomized trials have their place, but not so much in dietary studies. At least in my view. Why? Because it’s difficult to hide what kind of diet the people involved are following. If you know you’re in a study and are going to be randomized to either a low-carb or a low-fat diet, it’s pretty easy to tell which arm of the study you ended up in just by looking at the food you’re supposed to be eating.
You can randomize people into different diets if they’re formula diets. But not if they’re real food diets. And if you’re in a study using real food, and you’re not a fan of the foods in the group you got randomized into, then you’re not likely to follow the diet to the letter. It’s much better if you can pick which diet you would prefer and go with that group. But then people would decry the study for not being randomized.
In the study we’re about to discuss, a busy general practitioner in the north of England asked his diabetic and pre-diabetic patients if they would like to be involved in a dietary study using a moderately low-carb diet. Of his type 2 diabetic patients, 27 percent (128 subjects) opted into the study. He ended up adding 71 pre-diabetics to the study as well.
Dr. Unwin, who ran the study, wanted to see if an easy-to-follow low-carb diet implemented in a busy practice could bring about significant improvements in a disease that is reaching epidemic proportions.
At the start of the study writeup, Dr. Unwin discusses a handful of more rigorous low-carb studies in the literature showing improvement. Then he followed with the opinions of some naysayers:
In 2020, ADA standards of care for T2D report stated: ‘for individuals with type 2 diabetes not meeting glycaemic targets or for whom reducing glucose-lowering drugs is a priority, reducing overall carbohydrate intake with a low- carbohydrate or a very-low-carbohydrate eating pattern is a viable option’. However, there is still some debate about sustainability (particularly in terms of long-term adherence) and safety of lower carbohydrate diets. For example, an RCT comparing a low-carb diet to a low-fat diet in people with T2D8 found a similar 3.4% weight reduction in both dietary groups and no significant change in A1C in either group at 1 year. Also in 2018, the British Dietetics Association (BDA) stated: ‘more research is needed to ascertain the long-term health impacts of low- carbohydrate diets, including on heart health’. Beyond this uncertainty, little is known about the best methods of implementing advice on lower carbohydrate diets in primary care practice. [My bold for emphasis]
All in all, the typical mealy-mouthed, weasel-worded, hand wringing you often see. Always with the “more research is needed” words thrown in for safety.
When you have subjects in a study, especially an expensive study, you try to be as hands on as you can. You don’t want people dropping out, and you want to make sure they’re coming in frequently and getting all their questions answered. Just having them come in gives them accountability.
But in a busy general practice you can’t really do that unless it is the focus of your practice. So Dr. Unwin wanted to see how patients fared on their own with just a standard follow up a few times per year versus weekly, which is more common in most dietary clinics. Dr. Unwin estimated approximately three ten minute one-on-one office visits each year had been needed and provided access to an
optional 90 min evening group sessions that ran approximately once every 6 weeks. Group sessions included a psychologist who facilitated behaviour change by encouraging participants to consider their individual health goals, the resources avail- able to them, setting realistic steps and enabling the individual to notice what works for them.
His office also invited caregivers and food preparers to these optional group sessions. Approximately 25 people attended each session, so the majority of the patients didn’t participate often.
The patients received fairly simple instructions on what to eat. Below is the main instruction sheet. It doesn’t reproduce well here as the print is too small, but you can read it in the strudy.
Here is another graphic showing the sugar equivalents of a number of foods.
So, this is not a hardcore low-carb diet. It certainly isn’t a ketogenic diet. And the patients didn’t have a lot of interaction with the staff after they were started on the program.
How did they do?
Phenomenal wouldn’t be too much of an overstatement.
Of the patients at the end of the evaluation period, 63 percent were male, and average age was 63.
For those with T2D, there was a statistically significant reduction in all variables of interest other than a statistically significant increase in high density lipoprotein (HDL) cholesterol.
The greatest changes were in weight loss and for reduction in HbA1C. Patients dropped from an average of 99.7 kg (about 220 lb) to 91.2 kg (about 200 lb). And HbA1c dropped from 65.5 mmol/mol (8.1%) to 48 mmol/mol (6.5%).
94.4 percent of patients lost weight, but even those few who didn’t dropped their HbA1c by 21.1 mmol/mol (4.1%), which was similar to the average of the entire group.
Along with the improvement in diabetic parameters, these patients also achieved
significant reduction in total cholesterol, triglycerides and total/ HDL cholesterol ratio and a significant increase in HDL cholesterol seen in patients with T2D.
And they dropped their blood pressures as well.
54 patients were on medications for type 2 diabetes at the start of the diet. 29 medications were stopped over the course of the study. Some patients had more than one medication stopped. So 19 of the 54 patients on various medications ended up being medication free after their diet change.
The vast rise in the incidence of type 2 diabetes in the UK is putting a major strain on the NHS. The drug cost savings of these patients who were able to eliminate their diabetic medications calculates to a little over £50,000 per year. And that’s in just this one practice. Imagine how much money could be saved if all the practices adopted this mode of treatment.
I hit the high points, so I would encourage you to read the entire study. Unlike most, it’s a pretty easy study to read.
It shows the power of a fairly non-restrictive low-carb diet and what it can do to reverse type 2 diabetes.
Okay, that’s about it for today. I couldn’t find a worthy video this week. I’ll try to make up for it next week, but right now I’ve got to get back to my slide making.
I’ll be back next Thursday from Florida. Keep in good cheer, and I’ll see you then.
Drop by LowcarbUSA in Boca if you’re in the neighborhood and track us down. We’d love to say hi. If you can’t make it, don’t forget you can also sign up to attend the conference ‘virtually’ and see my talk and all the other good info online.