Disclaimer: I am not a physician and am only offering personal experience and references to public statements and medical literature. Consult your doctor for medical advice.
TL;DR
Internet shorthand for "Too Long, Didn't Read". Here is a short summary of results.
- Change your nutrition plan to Low Carb Healthy Fat [LCHF]. Skip a meal or two if it feels OK. This changes your daily nutrition to allow your metabolism to tap into your only long term energy storage [fatty acids] and gradually change your body composition to be healthier.
- TOTALLY avoid processed foods which are always high carbohydrate.
- TOTALLY avoid industrial seed/vegetable oils which damage the cell structure.
- Exercise more and sleep well and experience more joy!
Inspiration
John has been worried about declining health for several years. He has struggled with weight issues, blood pressure and sleep issues. John has observed some very early reduction in mental capacity – hard to perform self care tasks, forgetfulness etc.
NOT ADDRESSED HERE
• John still has sleep problems (sleeping long enough) several nights a week and uses a CPAP machine for sleep apnea, very successfully.
• John has stopped taking his acid reflux medication because the revised diet is easier on the stomach and the medication inhibits absorption of vital minerals, etc.
GOALS:
• Feel good
• Have energy
• Sleep well
• Be healthy enough to reduce medications without undue health risk
PURPOSE OF THIS DOCUMENT
A basis for a discussion with my primary care physician. The goal is to work closely on this with the goals of
Best case
o Get approval and support or at least an understanding that some well-respected members of the medical community are seeing things in a new light based on how our country is mis-managing its food and health program
o Getting medical source documentation and direction if I use incorrect data or conclusions, along with reasons for same and alternatives so the program as needed to achieve goals.
o Attain help with whatever medical tests needed to ensure we are on track. if a negative trend occurs I want to course correct quickly and effectively
Worst case
o Primary Care Physician will agree to monitor the project carefully and provide assistance on keeping us on a healthy course, including any required corrective changes
Physician Review Summary
The nutrition plan was considered excellent. When drawing conclusions from research, books etc risk factors such as family history, previous and current medical conditions such as sleep apnea need to be taken into account. In addition, the current medical belief is that the arteriosclerosis disease process is a "black box" and not fully understood.
Research Plan Approach
John started researching the health issues and general societal health issues in his usual methodical way: reading, study, searching for alternatives. This presentation is what he has concluded and the plan on moving forward.
Public Health issues Research
We start with a review of the current 30-40 year health disaster in the US and around the world – from some official and NGO (non governmental) agents. There are links to the sources, highlighted and underlined.
1) World Health Organization
• The number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014 (1).
• The global prevalence of diabetes* among adults over 18 years of age has risen from 4.7% in 1980 to 8.5% in 2014 (1).
• Diabetes prevalence has been rising more rapidly in middle- and low-income countries.
• Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation.
• In 2015, an estimated 1.6 million deaths were directly caused by diabetes. Another 2.2 million deaths were attributable to high blood glucose in 2012**.
3) Obesity trends
Obesity rates exceeded 35 percent in five states, 30 percent in 25 states and 25 percent in 46 states. The lowest rate was 22.3 percent in Colorado. [Behavioral Risk Factor Surveillance System (BRFSS), 2015]
In 1985, no state had an adult obesity rate higher than 15 percent; in 1991, no state was over 20 percent; in 2000, no state was over 25 percent; and, in 2006, only Mississippi was above 30 percent.
Public Health Research Conclusion
As the societal research shows, there has been a worldwide health change. WHO stated that world wide diabetes type 2 increased from 108 million to 440 million in 25 years. There is a parallel increase in obesity.
As an amateur scientist, John knows you cannot assume that coincidence implies causality. However it can draw attention for further study and research. One major change that happened in the late 1960s and early 1970s was a growing belief that humans would be better off eating less meat and more carbohydrates. This was formalized in the early 1980s when the US adopted Dietary Guidelines and also dietary Fat Guidelines. These Guidelines were replicated around the world over the next 10-15 years. They have been very effective. For one example consumption of red meat in the US declined by a third in the next 30 years.
There was no Randomized Control Studies to justify that decision. See this Phd thesis on the history and background 1950s-1970s. In that sense, the societal change was belief and hope driven instead of science driven.
Research on Cholesterol
Here are results from a study John made on human nutrition and metabolism. The source was from all sorts of books, papers and internet research. Many of these sources pointed to the cellular energy source called mitochondria which every multi-cell organism has and depends on.
The first conclusion involves the lack of importance of overall cholesterol values. There is a component of danger within, talked about later.
- HDL doesn’t need much discussion since all 5 types simply facilitate transferring fatty acids from energy storage.
- LDL is a sort of container shipment which transports triglycerides, cholesterol, and fat soluble vitamins to cells. A high level of LDL means more fat energy is being transported around and not fundamentally dangerous. A high carb diet naturally shows less LDL because more energy is being taken from glucose, with all the problems that the resulting high insulin creates. LDL does carry cholesterol around but that is normal useful building blocks for all cells in the body recovering from normal wear and tear and rebuilding efforts for replicating cells.
Review paper shows an utter absence of any relation between LDL-C and mortality.
Title: Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review
Cardiovascular medicine
Research
First published June 12, 2016.
Because of this conclusion I have ruled out Statin drugs. There are also papers showing statin adverse effects including increasing A1C and substantial weight gain. There are almost no benefits and considerable bad effects.
There is a dangerous LDL component called Remnant Cholesterol. See three references below.
[Remnant Cholesterol] It is very simply calculated: you just subtract HDL Cholesterol (HDLc) and LDL Cholesterol (LDLc) from your Total Cholesterol. For example, if your Total Cholesterol were 300, your LDLc 200, and HDLc 80, then you’d have a Remnant Cholesterol (RC) of 20. That’s 300 – 200 – 80 = 20.
Remnant cholesterol, also known as remnant lipoprotein, is a very atherogenic lipoprotein composed primarily of very low-density lipoprotein (VLDL) and intermediate-density lipoprotein (IDL).
Second Remnant Cholesterol research paper
Third Remnant Cholesterol research paper
ANALYSIS
Using John's latest blood tests and the graphs in the first Remnant Cholesterol Paper above. These blood tests were after implementing a Low Cab Healthy Fat nutrition plan and calculated his Remnant Cholesterol RC of 18… putting him in the Medium-Low Quintile of heart risk. Here are the calculation notes:
-==== CholesterolCode.com/Report v0.9.2 ====--
...2 months on LCHF (20g to 120g carbs) ::: 4 hours water fasted...
WARNING: fasting for less than 12 hours can risk confounded lipid numbers. See https://www.youtube.com/watch?v=ZQHztlN1Yls
Total Cholesterol:195 mg/dL5.04 mmol/L
LDL Cholesterol:132 mg/dL3.41 mmol/L
HDL Cholesterol:45 mg/dL1.16 mmol/L
Triglycerides:88 mg/dL0.99 mmol/L
--CHOLESTEROL REMNANTS--
Remnant Cholesterol:18 mg/dL0.47 mmol/L >>> Medium-Low Risk Quintile
Remnant Chol to HDL:0.4 >>> Medium Risk Quintile
Go to here for more on Cholesterol Remnants
--ATHEROGENIC INDEX OF PLASMA (AIP)--
AIP: -0.069 >>> Lowest Risk Third
Go to here for more on Atherogenic Index of Plasma
--CONVENTIONAL MARKERS AND RATIOS--
Friedewald LDL-C: 132 | Iranian LDL-C: 131
Total/HDL Ratio: 4.33
TG/HDL Ratio in mg/dL: 1.96 | in mmol/L: 0.85
So the Coronary Heart Disease risk is medium low, by this measurement.
Diabetes Conclusion and Action Plan
No one can deny that there is a coincidence between the dietary change and the health crisis in obesity and Diabetes.
When John studied and reflected on human metabolism, he saw these important factors.
• The human body has no way to store protein for long term energy use. Lean muscle mass can be broken down to glucose in an emergency but that is very inefficient.
• The human body has limited ability to store glucose in muscle cells and liver, a few minutes at the muscle cells and several days at the liver. The blood is limited to 5 grams maximum, the weight of two USA pennies.
• The human body has vast ability to store energy in fatty acids, or adipocyte [fat] cells.
• The mitochondria, which creates most of the energy we run on, can be run on fatty acids or glucose [transformed to pyruvate]. This ignores ADP-ADP emergency processing and other mechanisms.
• Glucose is absolutely necessary… it is vital for red blood cells and for creating a critical part of the citric acid cycle which prepares energy for mitochondria. However, it is not vital for major energy use itself.
A 1990s pioneer in Diabetes was Dr. Richard Bernstein see here. He taught that a low carbohydrate diet would benefit diabetics. My conclusions agree with Dr Bernstein and are that a low carb, sufficient protein, healthy fat diet is ideally suited for human metabolism. This being implemented should protect John from developing Diabetes Type 2.
It happens that other researchers and amateur popularizers have brought this to attention under the name of the keto-genic diet. In Standard Medical practice, this diet has been used successfully for managing severe epileptic conditions since the 1920s. Even today that diet is used when there is no effective epilepsy drug treatments. Because of this, we can be very sure that a low carb healthy fat diet can be tolerated and can sustain a long healthy life.
The American Diabetes Association has now accepted this as one approach here. Here is the relevant quote.
Low Carbohydrate
A low carbohydrate eating pattern focuses on non-starchy vegetables such as broccoli, green beans, kale, salad greens and protein foods like meat, poultry, fish, shellfish, eggs, cheese, nuts and seeds, fats (oils, butter, olives and avocado). Highly processed carbohydrate foods and grains are limited or avoided in this eating pattern. There is no standard at this time for the grams of carbohydrate in a low-carb eating pattern and research continues to look at the effects of this eating pattern on diabetes. Work with a registered dietitian who can talk with you about your current eating habits and help you figure out the plan that will work best for you.”
The ADA also advances Low Fat and other meal plans that are not justified by science. However, they no longer consider Low Carb Healthy Fat diet ridiculous or dangerous.
Carbohydrates and Diabetes
One aspect of a high carb diet is that the body manages the resulting rise in glucose [and sucrose and fructose] by releasing insulin. That is because glucose is dangerous in the blood and needs to be stored in liver and muscle cells [and other places, even adipocyte cells need some]. In storage it is combined with water molecules.
On a high carb diet, after years or decades the continued high insulin causes a failure where the body cannot produce enough insulin or the safe places to store glucose are “filled” to capacity. Then you get high blood sugars and resulting dangers. This is known as insulin resistance IR.
Where is John in the stage? His blood tests were taken after switching to a LCHF diet of about 2 months. Fasting insulin in blood work was added to help measure that. Some 15 years ago Dr McAuley developed a simple way to estimate IR. This has not been widely adopted, but the absolute best calculating method for Insulin Resistance involves many hours in outpatient with catheters pushing glucose and insulin into the bloodstream and drugs to block endogenous (self) insulin production. Dr. McAuely found a strong correlation between fasting insulin and fasting triglycerides and outpatient measured insulin resistance see McAuley Insulin Resistance Calculator.
John’s blood: fasting insulin is 3.9 and fasting triglycerides is 88 mg/dL.
McAuley index (high risk<6.05) 9.49
Your probability of having IR 7.8%
So he is well away from Insulin resistance.
Cholesterol Action Plan
Based on research above, John is not taking statins/cholesterol medications at this time.
Weight Management Action Plan
The goal is to create a healthy body composition. The easiest way this can be measured is the US Navy calculator. That requires only height and weight and body measurements. At John's age body fat per cent is healthiest from 13-25%.
John has been on this food program approximately 2 months. He has lost 20 lbs. and now in low 200s. He is taking no statin medications. A1C is 5.2. The Naval estimate of body fat% is 20%.
He is able to do intermittent fasting [skipping breakfast], is taking up Tennis and is feeling good. John will remain on this food program to attain goals.
Summary
What Changed in last 40 years?
1) Dietary Guidelines emphasized high carbs and low fats.
2) There was no Randomized Control Studies to justify that decision. See this Phd thesis on the history and background 1950s-1970s.
3) People followed guidelines and in fact red meat consumption in USA dropped by 1/3.
4) A massive increase of obesity and diabetes type 2 followed, especially after the dietary guidelines were published in early 1980s. This was mimicked around most of the world with the same results.
Studies of human metabolism convince John that
1) Humans are mostly meat eaters by basic metabolism. Most convincing argument is that we only have an ability to store large amounts energy as fatty acids. During millions of years as we evolved there were long periods where we had to fast… so having a portable supply is essential.
2) We are overfeeding because carbs => glucose is addictive: will power means nothing. In rat model test, glucose was more addictive than cocaine.
3) Calorie restriction doesn’t work, proved every day. The body itself reduces basil metabolic rate to balance the calories and so Calories In - Calories Out model is just too simple.
4) High Carb and Fat together prevents body from accessing fat storage for energy. Insulin suppresses fat release from adipocyte tissues. It causes an insulin spike and then drop and then renewed hunger.
5) Glucose is absolutely needed, for example for Red Blood Cells and cellular respiration, but at a low level.
6) At the cellular level, the mitochondria energy cells common to all non-bacteria living biological systems can be fueled by glucose [slightly transformed] OR fatty acids. ATP pops out of the ATPsynthase at the end of the Electron Transport Chain… no matter the fuel. And ATP powers each cell.
Current Action Plan
1) Follow Dr. Richard Bernstein’s prescription of a low carb, healthy fat diet
2) That diet been used since 1920s until today as a last ditch Epilepsy treatment, so physically proven safe
3) Dr. Richard Bernstein’s plan has recently become popular as Keto-Genic diet, with many promoters. One of the recent popularizers [Jason Fung] was a speaker at the Spring 2018 Obesity Medical Association. His talk emphasis was on using fasting as therapeutic.
4) Use intermittent fasting [like skipping breakfast] to burn off existing fat stores over some months or a year
5) After achieving health body fat%, eat more to stabilize weight. John is at stabilized goal and 20%.
Diabetes
1) Low carb results in low insulin and thus natural low blood sugars
2) This will protect John from developing Diabetes type 2.
1) Take no statins. Monitor heart as directed by my Physician
Weight
1) Continue with food and exercise program to reach goals and stabilize.