las

Welcome all seeking refuge from low carb dogma!

“To kill an error is as good a service as, and sometimes even better than, the establishing of a new truth or fact”
~ Charles Darwin (it's evolutionary baybeee!)

Saturday, February 2, 2013

The problem with (NOT) giving medical advice in the Incestral Health Community

Just about every major blogger and guru in the IHC has a lengthy medical disclaimer page.  They are not providing medical advice on the internet because if they are an MD it's illegal (my understanding of the law, feel free to correct me if I'm wrong here),  and if they are not, it's illegal to practice without a license.  Same goes for nutritional advice and all that.  

Right after the medical disclaimer, where you've usually been given the "I have no special training in what I'm about to convey" spiel, or, the flipside, the disclaimer is signed with a name and a litany of letters after it.  And from time to time, you get nothing more than a telling of someone's story on how they cured themselves.  The IHC is big on this.  One of the more recent trends in the IHC is the promotion of ketogenic diets for curing cancer.  I consider this to be wholly irresponsible unless there is a focus on using the diet in conjunction with medical therapies that have been proven effective.  I don't see enough of that in this community, rather too much of the opposite of doctor bashing.  

People with the purest food supply still get cancer.  Unless you are going to live in a bubble somewhere you are going to be exposed to toxins and radiation.  There are any number of natural substances and agents that are toxic to the human body, and we cannot completely prevent exposure to the many man-made ones either.  Cancer cells are produced all the time for no apparent reason, just a "mistake"!  This is a personal thing with me, my mother just celebrated being a 20 year breast cancer survivor last month!  I recall when she was diagnosed how scary it was, Mom had always been a bit of a "health nut" and we didn't have processed crap in our homes.  One could call her a semi-WAPFer and we consumed many veggies that were grown in our garden year round (frozen/canned).  We ate brown organic eggs, shunned all food colorings, preservatives, etc.  I'm sure that some in the audience would love to analyze our diet and pick out some foods that caused her cancer because of something they read on the internet or the latest anti-cancer diet book.  

Whenever someone famous gets or dies of cancer, you can bet the IHC will blame the vegan diet if that person followed one.  Witness Steve Jobs death from pancreatic cancer.  At right is a Google search on Steve Jobs vegan diet (no cancer in the search terms, you can click to enlarge.)  A peddler of coffee around the IHC topped today's search, and Dr. CarbsCanKill Su came in halfway down the page using Jobs' death as evidence that carbs do indeed kill.

But Jobs death from pancreatic cancer might well have been prevented had he sought conventional therapy early on rather than going the alternative route.  

I started my research career some 23 years ago working on pancreatic cancer. It is a relatively rare, yet ugly and often aggressive disease that usually is asymptomatic until later stages. The type Steve had was an "islet cell neuroendocrine" tumor, a somewhat less aggressive type that is more responsive to early treatment. When Mr. Jobs was first diagnosed in 2003, he chose to pursue alternative therapies, including acupuncture, herbal, diet and fruit juice therapy and spiritual consultations. Many of these therapies he found on the Internet. Despite pleading from his distressed family, friends and physicians, Steve chose to delay surgery and chemotherapy for 9 months. When dealing with aggressive cancers, a delay of this magnitude can shave years off of one's life. However, chemo and surgery are not without their unpleasant side effects either.
The author of this article in Psychology Today goes on to discuss risks and those unpleasant side effects and conveys her respect for those choosing alternative paths.   So she's not bashing Jobs here. However she does shed a light on what really contributed to his death -- if anything but the cancer itself.  The thing about conventional therapies is that we actually have some risk-benefit statistics to help us make our decisions.  In my mother's case, technology was already at a point where they could identify different types of breast cancer and different treatment approaches and the effectiveness thereof.  Ultimately she opted for lumpectomy, chemo and radiation but she opted out of tamoxifen after a short stint.  Her radiation was also cut a tad short as she didn't react very well and her tests were all pretty clean from the chemo, so it was a decision reached with her doctor.  I do believe she added a few supplements to her repertoire as well.  And she tightened up on her diet a bit, but is far less rigid now than I have ever seen her be.  

Which brings me to the impetus of this post.  A recent guest on the LLVLC show, that valuable conduit of information in the IHC:  The LLVLC Show (Episode 650): Elaine Cantin Beat Her Breast Cancer, Son’s Type 1 Diabetes With Ketogenic Diet.  Now Cantin is an interesting character as she wrote a book and somehow managed to create a "new" diet she slapped her name on out one that's been around for at least a century (for epilepsy) and likely long before.    I must say that what initially caught my eye was the claimed "cure" of Type 1 Diabetes, and we'll get to that shortly, but (and I didn't listen to this podcast) from the shownotes, Cantin discusses:
  • Ketogenic diets have been described as “fed starvation”
  • You can feed your body and still starve the cancer
  • The hundreds of autoimmune issues her diet is good for
  • ALS, Parkinson’s, Alzheimer’s and other brain diseases too
  • What kind of response she’s seen from her ketogenic diet
  • People are fed up with conventional treatments for cancer
  • The woman who’s lung cancer tumor is shrinking
  • It’s been two years since she’s been in remission from cancer
  • She never did any chemo or radiation…just ketogenic diet
  • She was told her cancer was aggressive and needed chemo
  • They scared her into thinking it would move into her bones
  • Her doctor says she is in complete remission from cancer
  • She feels fine these days despite bucking convention
So I went to Amazon.com to see what her book was all about.  This review was on the sidebar:
If you've been diagnosed with breast cancer, be careful in interpreting this book. The author almost incidentally admits to having a lumpectomy and taking tamoxifen for a year to two years after diagnosis, while crediting her ketogenic diet for treating her breast cancer. This is important because both lumpectomy and tamoxifen are the two most effective treatments for estrogen and progesterone receptor positive, HER2 negative breast cancer. It has recently been established that a regimen of ten years of tamoxifen rather than the previously prescribed 5-year regimen is best in preventing recurrence. One must also take into consideration that the author's diagnosis of breast cancer in 2010 and the publishing of this book copyrighted in 2012 does not necessarily mean she is cured. She refused a mammogram in January 2012. Metastasis can reoccur in any part of the body, not just the breast, and may not show symptoms for some time. If the author had written this book ten years post-treatment, and undergone mammogram, MRI, and/or ultrasound with favorable outcome, it would perhaps be more convincing.
This reviewer is a "confirmed purchase" and she raises some key points that one would not get from the show notes (and presumably the podcast, sorry I can't listen to too much of this stuff).  Cantin essentially underwent the appropriate medical treatment for her cancer and used a ketogenic diet in conjunction with it.  Whether or not her keto diet is responsible for a very short-term, unconfirmed remission is unknown.   I would say that the "beating cancer" at this point is due to having it cut out, however.  Period.  As the reviewer points out, lack of any more sophisticated tests and the short duration of her remission hardly makes the case for her diet.  But Jimmy hears about someone using ketosis to cure stuff and he's on it for the interview!

But I think I am more bothered by her son's type 1 diabetes.  From the show notes:
  • Her son was diagnosed with Type 1 diabetes and hospitalized
  • He experienced having a lot of ketones while he was sick
  • This enabled him to come off insulin for a few days
  • Starvation actually produced an adequate amount of ketones
  • You can replace starvation ketones with a ketogenic diet
  • How her Type 1 diabetic son is doing on ketogenic diet
  • She did test her diet on her son and he didn’t need insulin
When I read stuff like this I wonder if people in the LC wing of the IHC have any clue what the real problem is in T1.  What actually used to kill humans before insulin was discovered.  It is the KETONES!  Which does not mean that mild ketosis is dangerous, but diabetic ketoacidosis is what kills diabetics and it is due to very high levels of fatty acids that are converted to ketones.  As even one commenter on Jimmy's blog mentions, "nothing novel about starvation diets for treating type 1 & 2 diabetics… the tragedy is why the method had been forgotten about for so long. Here’s a book from 1916!!!"  Tragedy??  Here is a timely article on PBS:  How a Boy Became the First to Beat Back Diabetes:
On Jan. 11, 1922, a 14-year-old boy hovered between life and death. His name was Leonard Thompson and he was suffering the end stages of diabetes mellitus.

Because the only treatment available was a starvation diet, the boy weighed a mere 65 pounds when he was admitted to the Toronto General Hospital. Worse, Leonard was drifting in and out of a diabetic coma. His father was so desperate to save the boy that he agreed to let the doctors inject Leonard with a newly discovered wonder drug that had never been tried on another human being. The doctors called it insulin.
It was a starvation diet.  There are many case studies like Thompson's in the peer review literature (sorry, time doesn't permit hunting down the links, feel free to help me out).  Because of insulin, diabetics live much, much, longer now. It is a hormone of LIFE.   But the discussions of insulin in this community are so utterly ill informed and hostile towards this hormone, people fear it!  I blame Taubes and Eades and all the rest of these people who have demonized this hormone and contributed to widespread misunderstanding of it's purpose and action.  Even Bernstein doesn't shun insulin, he's just operating on his premise of the law of large numbers or something like that and feels better glycemic control is possible with smaller carb and insulin doses.  

Insulin saved Leonard's life as it has saved countless others since.  I only hope that Cantin's bragging of her son's T1 treated w/o insulin means he is not T1 but rather MODY or some other form where he makes some insulin endogenously.  What I find tragic is that people like Jimmy's commenter exist who think it is tragic that we've abandoned starvation diets in favor of insulin.  Jeez.  Why do these people hate diabetics so?  Really, I'm not fond of using that word, but there seems to be no greater evil on the planet to some of these people than the diabetic who chooses to eat a normal amount of carbohydrates and dose themselves appropriately with insulin.  Why the hell should they not be able to do that without your derision?  Your pancreas does it when you eat carbs, or when you did eat them.  I've made the analogy to thyroid here many times.  Nobody seems to have any issue with supplementing a malfunctioning thyroid, but the pancreas?  No that hormone is a last resort!!  Rosedale thinks it is criminal to give insulin to a T2, a position he did not waver on despite being shown studies on the efficacy of early insulin treatment in reversing diabetes.    

People are getting scare mongered out of seeking appropriate therapies for their diabetes.  On Jimmy's forum there were diabetics who just refused insulin or are prematurely taken off of it and other related drugs (like metformin) by doctors like Mary Vernon.  And people read this on the internet and they develop irrational fears of a life-saving hormone.  This is fueled by the enormous amount of misinformation about insulin bantied about this community.  And it's perpetrated by podcasts touting Cantin and responses like the one Jimmy made to Mr. Tragedy quoted earlier:  "Yep, it worked then out of necessity but it will work now out of prudence."  Prudence?   Prudence?  I don't think it is prudent to revisit starvation diets to treat diabetes.  Do you?  

Insulin therapy has come so far from the early days.  The biggest risk, hypoglycemia, is easily prevented by exercising prudence in diet and insulin dosing.  Those meters you are so fond of, Jimmy, are intended for diabetics so that they can best monitor their situation and treat their disease appropriately.  With the advent of insulin pumps, we are one step closer to approximating life with a functioning pancreas.  Much is left to learn and develop, but much has already been learned about insulin and its action.  Promoting people like Elaine Cantin in the face of such, who seems to advocate for a return to inferior treatments in every way (for diabetes), is not helpful, it is potentially harmful.  

In the coming weeks I hope to share with you two reviews from the peer-reviewd scientific literature  on insulin resistance, and begin anew a dialog on this topic that is so horribly misunderstood in the IHC.  It is far from a solved case in the medical/scientific realms, but this doesn't mean we don't know a lot about it thusfar.  Many times science is best at shooting down flawed hypotheses, and in this arena this is a repeated occurrence.  


155 comments:

Charles Grashow said...

http://www.youtube.com/watch?v=OpvyHjqjW3Y

How To Cure Breast Cancer and Modified Ketogenic Diet with Elaine Cantin

Diana said...

Fantastic post, Evelyn.

AFAIC, promoting such "treatments" (actually, pseudo-treatments) isn't just potentially harmful, it is unconscionable. This exposes Jimmy's overweening grandiosity in all its pathology.

Who the f*ck is he to pass judgement on any conventional medical modality? Especially one that he has no personal experience with? And Mr. Sticks of Butter who has admitted in public that he doesn't like to stop eating once he's started, is touting starvation? This is downright obscene.

He is not a buffoon. He is a menace.

George Henderson said...

Is it not tragic that we've replaced low-carb diets and however much insulin that requires, with all the cake you want and as much insulin as it takes to "cover" it? Low carb diets didn't die off with the introduction of insulin but as insulin became safer and more reliable. Porcine insulin, you might try to limit that.

Sanjeev said...

> This exposes Jimmy's overweening grandiosity in all its pathology.

He may not believe it, may just have realized (or focus-grouped or actually tested, using controlled tests of articles and donation levels for example) that anti establishment message resonates with his audience

A lot of internet marketers, even on small sites, are getting very VERY sophisticated in testing the return on investment / time / effort of their marketing materials.

Sanjeev said...

Like the marketing surrounding those tee shirts

There's more sympathy - mongering and victimhood coming down the pike, IMHO. Maybe a lot more.

Gabriella Kadar said...

Whether the ketogenic diet provides any improvement on outcome for various types of cancer, I have no idea. But it is true that tumour cells because they are going through rapid mitosis utilize more glucose. I don't know anything about whether, metabolically, tumour cells can switch to ketones or fatty acids. Radioactively labelled modified glucose is used in imaging studies of various types of cancers. So I guess it's one of those 'it's only logical that' types of conclusions that some people arrive at.

Basically though, when empty calories are replaced by nutritious food, it's a good change. When people are trying to not gain weight but at the same time consume a significant percentage of their daily caloric intake as sugar in all its manifestations, it's easy to not consume the appropriate amounts of anything from potassium, magnesium, B vitamins and etc. etc.

The only person I know who went on the real ketogenic diet due to epilepsy had to stop due to an alarming weight loss. I would assume losing weight like that if someone had cancer wouldn't auger well for survival with some of the more aggressive forms of chemotherapy. Recent news releases claim that a bit of chub provides a better start point.

Unknown said...

The problem is that many of the gurus are giving advice to people who are mentally ill, because who the hell else are they going to give advice to?

Diana said...

"s it not tragic that we've replaced low-carb diets and however much insulin that requires, with all the cake you want and as much insulin as it takes to "cover" it?"

It would be tragic if that's what the medical profession said. But I think you are making things up, George. Doctors tell patients to cut the crap.

Princess Dieter aka Mir said...

Years and years ago, and I don't remember specifics, but there was a case I read of gal touting a raw vegan type of diet as having cured her cancer. But it was revealed that she had had standard M.D. treatment prior to going to that special clinic for her food cure.

Look, humans fudge and humans emphasize the wrong things sometimes. We believe as we wish. But I think any case where someone got standard care alongside or before non-standard care should not be used to bolster any non-standard care. I don't believe M.Ds are the sole source of wisdom about health. But I do think to give Dr. RawJuice all the credit when Dr. Surgery/Chemo helped, too, it's misleading. Maybe outright fraud.

I believe eating well and handling stress, etc, can add to one's arsenal to fight any disease. But you bet that if I got diagnosed as diabetic, I want the best the standard docs have to offer. Gimme insulin. And then I'll go and figure out what diet might be best. I don't doubt lowering carbohydrates to use less insulin might be a great way to go (maybe even just for cost saving).

Cantin makes me angry for putting the emphasis on the diet when what she really is benefitting most from is the standard medical care. If a single person eschews sugary or other effective txs cause of that book, she might have blood on her hands. Shameful.

If it were the ketogenic diet ALONE that put her in remission or something, then yeah, crow about it. But this is disgraceful. There fiery pants in her closet...


Evelyn wrote: ~~In the coming weeks I hope to share with you two reviews from the peer-reviewd scientific literature on insulin resistance, and begin anew a dialog on this topic that is so horribly misunderstood in the IHC.~~

THIS makes me squee. Looking forward to it.

Princess Dieter aka Mir said...

I wrote: single person eschews sugary

um. SURGERY.

I must have carb-brain syndrome. ; )

Charles Grashow said...

http://artisopensource.net/cure/wordpress/wp-content/uploads/2012/12/Seyfried-et-al.-Is-the-restricted-ketogenic-diet-a-viable-alternat.pdf

Charles Grashow said...

http://www.nutritionandmetabolism.com/content/7/1/33

Metabolic management of glioblastoma multiforme using standard therapy together with a restricted ketogenic diet: Case Report


Abstract
Background
Management of glioblastoma multiforme (GBM) has been difficult using standard therapy (radiation with temozolomide chemotherapy). The ketogenic diet is used commonly to treat refractory epilepsy in children and, when administered in restricted amounts, can also target energy metabolism in brain tumors. We report the case of a 65-year-old woman who presented with progressive memory loss, chronic headaches, nausea, and a right hemisphere multi-centric tumor seen with magnetic resonance imaging (MRI). Following incomplete surgical resection, the patient was diagnosed with glioblastoma multiforme expressing hypermethylation of the MGMT gene promoter.

Methods
Prior to initiation of the standard therapy, the patient conducted water-only therapeutic fasting and a restricted 4:1 (fat: carbohydrate + protein) ketogenic diet that delivered about 600 kcal/day. The patient also received the restricted ketogenic diet concomitantly during the standard treatment period. The diet was supplemented with vitamins and minerals. Steroid medication (dexamethasone) was removed during the course of the treatment. The patient was followed using MRI and positron emission tomography with fluoro-deoxy-glucose (FDG-PET).

Results
After two months treatment, the patient's body weight was reduced by about 20% and no discernable brain tumor tissue was detected using either FDG-PET or MRI imaging. Biomarker changes showed reduced levels of blood glucose and elevated levels of urinary ketones. MRI evidence of tumor recurrence was found 10 weeks after suspension of strict diet therapy.

Conclusion
This is the first report of confirmed GBM treated with standard therapy together with a restricted ketogenic diet. As rapid regression of GBM is rare in older patients following incomplete surgical resection and standard therapy alone, the response observed in this case could result in part from the action of the calorie restricted ketogenic diet. Further studies are needed to evaluate the efficacy of restricted ketogenic diets, administered alone or together with standard treatment, as a therapy for GBM and possibly other malignant brain tumors.

Diana said...

"Insulin Resistance" - resisting the fact that insulin is a benign and essential hormone. This syndrome is often found in LC/Paleo circles.

There is as yet no known cure.

Lighthouse keeper said...

It is often said that doctors only get 7 hours worth or whatever of nutrition tuition in medical school and therefore have no clue about it's effects on the human body, yet it is in the scientific field of medicine where the cutting edge expertise lies in all the body functions that nutrition could possibly have an impact upon. Does for instance a gastro-enterologist with forty years of experience have less clue about the effect of wheat on the digestive system than a paleo blogger?

Evelyn aka CarbSane said...

Actually I'm not sure why it always has to be LC or the all cake diet with folks like you George. It appears to be quite individual and many have a harder time managing their blood glucose levels on a high fat diet. This notion that anyone brags about not needing insulin for a T1 is troublesome. The case studies in the literature and even articles such as the one I linked to but that go into greater detail as to what the short lives of diabetics were before insulin really demonstrate that bragging on getting her son off of insulin (presumably not entirely) is extremely wrongheaded.

Dustbunny said...

@ Diana: "is it not tragic that we've replaced low-carb diets and however much insulin that requires, with all the cake you want and as much insulin as it takes to "cover" it?"

"It would be tragic if that's what the medical profession said. But I think you are making things up, George. Doctors tell patients to cut the crap."

He's not making it up. I have a good friend with Type 1 diabetes and that's exactly what she does. I don't know if the medical profession said anything like that but Type 1's have figured it out for themselves so they can have that giant slice of chocolate cake.

Charles Grashow said...

http://www.cnn.com/2010/HEALTH/11/08/twinkie.diet.professor/index.html

Twinkie diet helps nutrition professor lose 27 pounds

"For a class project, Haub limited himself to less than 1,800 calories a day. A man of Haub's pre-dieting size usually consumes about 2,600 calories daily. So he followed a basic principle of weight loss: He consumed significantly fewer calories than he burned.

His body mass index went from 28.8, considered overweight, to 24.9, which is normal. He now weighs 174 pounds.

But you might expect other indicators of health would have suffered. Not so.
Haub's "bad" cholesterol, or LDL, dropped 20 percent and his "good" cholesterol, or HDL, increased by 20 percent. He reduced the level of triglycerides, which are a form of fat, by 39 percent."

Haub's sample day
Espresso, Double: 6 calories; 0 grams of fat
Hostess Twinkies Golden Sponge Cake: 150 calories; 5 grams of fat
Centrum Advanced Formula From A To Zinc: 0 calories; 0 grams of fat
Little Debbie Star Crunch: 150 calories; 6 grams of fat
Hostess Twinkies Golden Sponge Cake: 150 calories; 5 grams of fat
Diet Mountain Dew: 0 calories; 0 grams of fat
Doritos Cool Ranch: 75 calories; 4 grams of fat
Kellogg's Corn Pops: 220 calories; 0 grams of fat
whole milk: 150 calories; 8 grams of fat
baby carrots: 18 calories; 0 grams of fat
Duncan Hines Family Style Brownie Chewy Fudge: 270 calories; 14 grams of fat
Little Debbie Zebra Cake: 160 calories; 8 grams of fat
Muscle Milk Protein Shake: 240 calories; 9 grams of fat

Totals: 1,589 calories and 59 grams of fat


SO - do calories count or not??

OnePointFive said...

Stories like that horrify me.
Yes,he could have Mody but he's just as likely to be in his 'honeymoon' period. A very low carb diet may delay the inevitable but without insulin he will eventually develop DKA.

Having had DKA, it's not something I want to do again so I'll steer clear of her advice. I check for ketones if I'm ill or have a rare high glucose level, unlike Jimmy I don't want to find them.

I have certainly never been told to eat as much cake as I want and 'cover it with insulin though I must admit that I do occasionally eat cake.
I've been able to complete a couple of marathons and am happy to be able to do daft things (joined my grandchildren on a climbing wall the other week.) I can't imagine anyone dreaming of someone with diabetes being able to do that back in the days of the Allen diet.
If I'd have been diagnosed back then, I might have survived a few uncomfortable years but I would probably have been dead by now

The diet pre insulin was the Allen 'starvation' diet as recommended in the comments on the Jimmy Moore blog.
During this period the length of time from diabetes 'onset' to death was 6.1 years (range 2.9 years for under 10s - 8years for those 40-59.(that was my age bracket so definitely on borrowed time)
By the time the paper was written in 1951 Joslin was able to report of people who had lived 25-30 years with diabetes.
Now we have people who have survived up to 80 years with T1
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2037674/pdf/brmedj03598-0003.pdf

From the Banting Nobel lecture
referring once again to Joslin.
'Of the 130 children treated with insulin, 120 are still living, while of the 164 who did not receive insulin, there are 152 dead.'
.
http://www.nobelprize.org/nobel_prizes/medicine/laureates/1923/banting-lecture.html

I'll stick with my insulin, a healthy mixed diet with some exercise and have every hope of being around for a good few years yet.

Evelyn aka CarbSane said...

My response to this would be "so what"? Does her doctor think your friend should do that? And so what if T1's have figured that out. If they can do it what's it to you? You can with your intact pancreas, so if they can get to know their bodies and dose with appropriate insulin, that is probably better for them given the extensive non-glucose homeostasis roles of insulin in the body.

Lighthouse keeper said...

Just goes to show what eating less can do for you even if "demonised" foods abound.

Karen said...

Humm I do believe there is a cure! I am/was Insulin Resistant in two ways of speaking. I am T2 diabetic and just left LC. My change from LC came from reading and reading and reading this blog. I resisted it for quite a while but have changed to counting calories with an eye on carbs. I even have a tiny piece of cake today! And it made me quake. LOL Thank you Evelyn.

Sue Staltari said...

Apparently cancer cells can utilize ketones depending on the type of cancer according to Jaminet who has done some posts on cancer and ketogenic diets.

Evelyn aka CarbSane said...

Having had DKA, it's not something I want to do again so I'll steer clear of her advice. I check for ketones if I'm ill or have a rare high glucose level, unlike Jimmy I don't want to find them.

It sounds like DKA may have been what landed him in the hospital? Or hypo in which case they withheld insulin and his ketones went up? I don't know, but this is troubling to me. I believe you've posted links here on the lifespan of diabetics (or perhaps you've just commented on them or like you have here) . I don't get the anti-insulin attitudes :-( If I am ever diagnosed with diabetes, I am not avoiding it at all costs that's for sure!

Karen said...

sadly it has been what some drs. say. and nutritionists. Common sense should tell one different. I do think for a T1 that is brittle watching carbs so there isnt the swing would be a good thing.

Evelyn aka CarbSane said...

:D

I am in agreement about the "just one person". That's how I feel. The problem with these n=1 things is that heck, try it, it might work for you, but even when documented, you don't know what other knowledge that person has (e.g. if they even stuck to their "plan" whatever it is) or test results they may downplay or outright hide.

My mom is evaluated annually. It is always a tense time for her followed by great sighs of relief. Cantin doesn't even know for sure if she is cancer free apparently since she apparently refused tests (that she relates in her book).

In the interests of saving time, I'll point out that Diana just had the following exchange with Jimmy on his blog:

Diana: Are you actually recommending diabetics starve?
Jimmy: Nobody is saying that. But a ketogenic diet mimics the effects of starvation in killing cancer cells.

First, this was a point on this diet for multiple purposes. Diana asked about diabetics and he came back with unsubstantiated claims vis a vis cancer.

Chemo works by killing dividing cells before it kills your healthy cells. By this logic if keto works the same way, then ...

Diana said...

I just answered him. Let's see if he posts my answer.

Evelyn aka CarbSane said...

Hi Karen! Good to see you in these parts! Tis true that some may inform patients/clients that insulin is license for poor eating -- I know two T1's who could do much better at controlling their blood sugars (and one has had some pretty serious complications already by age 40) and watching their diets. However if one has the technology and gets to know their body and can work out a dosage scheme that works for them, it's the demonization of this that bothers me. In many ways I think it may well be better to use normal amounts of insulin vs. avoiding it as much as possible.

Emily Deans said...

Brain tumor treatment could possibly benefit from a ketogenic diet. As for tumors in the rest of the body, I'm not so sure. Blood glucose doesn't drop below a certain amount due to gluconeogenesis for a reason. And folks undergoing chemo or radiation need adequate nutrition such that a ketogenic diet might be detrimental if not done thoughtfully. There needs to be more study, frankly. ;

Gabriella Kadar said...

@ Lighthouse keeper, the problem is doctors are not paid to provide nutritional counselling for patients. So whether doctors learn more after they finish school, it's almost irrelevant in their practice. Dentists have procedure/treatment codes for nutritional counselling but insurance companies don't provide coverage and then patients have to pay out of pocket.

Plus these days with all the polarization between various dietary hypotheses, bringing up the subject of appropriate/better diet can be more fraught than talking about religion, politics or sex. Sometimes religion and dietary restrictions coexist.

So I will explain to a patient what it is when they have a 'hypoglycemic' reaction (although actually having a measurable blood glucose that is hypoglycemia isn't really what's going on) and make suggestions for how they could consider modifying their breakfast, for example. But when people give me the 'but eggs will raise my cholesterol, cheese is saturated fat, oooo yuk, I couldn't even think of eating sardines on toast for breakfast...I don't like nut butters or trying hummus.' My thought is 'f**k it'.

I ate sautéed lamb kidneys with sour cream and Kozlik's Triple Crunch mustard with rye toast for breakfast today. Something that would gross out the majority of North Americans. Sometimes I'll fry up lamb chops. Sometimes I eat fish or Gordon Ramsay's scrambled eggs. For most people this is over the top. My attitude is I need to honour the needs of my body and I'm willing to invest the time to do this. I won't leave home and expect commercial food producers to be responsible for this.

Sometimes I ask people, 'at what age did your grandparents die?' If it's some ripe old 90s, I just tell the patient maybe eating like their grandparents did would be a good idea. That seems to resonate best. Unfortunately not everyone is lucky enough to have had ancient grandparents.

Nothing is simple when it comes to human to human interaction.

Some people complain that doctors only write prescriptions. I ask, 'what do you think happens if a doctor, instead of writing a prescription for drugs tells the patient that no drugs would be needed if the patient loses 50 pounds.' The vast majority of patients wouldn't lose any weight at all. The Standard of Care is to write prescriptions and do follow ups. Ultimately even in these cases, it is up to the patient to get them filled and take the drugs. Plenty of them don't do this either.

Actually the gastro-enterologists I've had dealings with were pretty darn knowledgeable.

What would you say to a patient who wants your opinion about the diet promoted by Colin Campbell? Or whichever vegan is 'guru de jour'? Especially after that person has spent hours and hours watching and listening to the 'guru' and is heavily invested in whatever it is? The patient wants to know if I am informed and a confirmation of their conviction they are on the right miracle track of health through food. They don't *really* want my opinion. Replying with "Are you totally crazy?" just wouldn't be appropriate.

Lucky me: I spend a standard 50 minutes with recall patients. Lots of things get said and much information is exchanged. But my family GP spends about 10 to 15 minutes with her patients which does not provide time for discussions.

Manythings said...

Karen

I am wondering how counting calories will help your T2 diabetes. It is not a technique I have seen recommended for diabetes by anyone. Counting calories is not a substitute for limiting carbohydrates when you have diabetes.

Do you check your blood glucose levels with a personal meter? It is the only accurate way to find out if you can tolerate a particular food, such as a piece of cake. There is no blog that can tell you whether it is (or is not) safe for a diabetic person to eat cake.

I have a brilliant recipe for cake made with almond flour and xylitol that tastes fabulous and is very low carb. It is possible to stay low carb and eat cake!

Best wishes,

Josh said...

"Adults did relatively well on this regimen [starvation regimen], but children
hovered miserably between death from diabetes and death from starvation. One 12-year-old boy, already blind from diabetes, was reduced to eating toothpaste mixed with birdseed stolen from his pet canary. ‘These facts were obtained by confession after long and plausible denials’, remarked the pitiless Allen. The unfortunate child died of starvation. A few physicians hailed the treatment as a
means of prolonging life, but Carl von Noorden shuddered and turned away when Joslin showed him one of his cases. The controversy concerning the value of extra months or years purchased at the cost of so much misery was very bitter, and Allen was banned from the diabetic clinic at the Rockefeller Institute in 1918." - Diet, delusion and diabetes - http://www.ncbi.nlm.nih.gov/pubmed/19018511

Nigel Kinbrum said...

Yes, but I would be hungry and miserable eating that little food each day (unless Muscle Milk Protein Shakes are really filling). On an ad-lib diet of junk, I (and a lot of other people IMO) would eat over maintenance kcals/day.

On the other hand, a diet of plain boiled potatoes would almost certainly result in weight loss. However, I would then be miserable due to dietary boredom!

Dustbunny said...

@Evelyn - I don't know why you've got such an attitude about what I said. What my friend does with her insulin is nothing to me. I was just commenting on the irony that George pointed out.

Charles Grashow said...

http://diagnosisdiet.com/ketogenic-diets-for-cancer-and-beyond/

Goals of this Experiment

To see if I can reach Dr. Seyfried’s “zone of metabolic management.”
To see if I can maintain high ketone levels and low blood sugar levels using an all-meat diet [my usual diet consists of nearly 100% meat, whereas standard ketogenic diets tend to rely heavily on high-fat dairy products, eggs, and coconut oil, none of which I tolerate well].
To explore the impact of protein:fat ratios, calories, and exercise on ketone and blood sugar levels.
To measure the effect of various sugar substitutes (Splenda, Stevia, Nectresse, etc.) on blood sugar and ketone levels.
To explore the effect of high-fat dairy products (heavy cream) on blood sugar and insulin levels.
To compare urine ketones to blood ketones and see if there is any correlation
To document effect of this diet on mood, energy, concentration, weight, sleep, etc.
To document any side effects of this diet.

Charles Grashow said...

I think this man is losing his mind

http://livinlavidalowcarb.com/blog/nk-n1-addendum-hourly-weight-blood-glucose-and-blood-ketone-testing/17842
"I’ve noticed during my experiment that my ketone levels tend to be lower in the morning and higher at night, but I didn’t know what was happening in the hours throughout the day and wanted to know. Plus, I’ve been wondering what was going on with my blood sugar after meals and exercise. And just for fun (because the fluctuations that happen throughout the day are pretty much irrelevant), I tested my body weight fully clothed every hour as well. My poor fingers took a pummeling with about 20 finger pricks a day on average (sometimes the lancet didn’t go deep enough to produce enough blood with just one finger prick), but this information was totally worth the temporary pain."

Sanjeev said...

there has been extensive discussion here about crash diets (intervention study), bariatric surgery(observed side effects for T2 diabetics) and lowered NEFA (biochem mechanisms) improving pancreas function and T2 significantly.

Sanjeev said...

IOW, 3 independent lines of evidence, and this blog doesn't go out of its way looking for these, AFAICT.

Evelyn aka CarbSane said...

The attitude is one of annoyance and frustration initiated by George. The T1's I know have never been encouraged to eat like crap and just dose insulin, but clearly many do. What happens for some of those is that they become IR and require more insulin. Why are these dogmatic low carbers so invested in everyone joining the cult? Hope Warshaw was eviscerated for daring to suggest that diabetics deserve to live a normal life. I mean Karen posts that she was able to eat a small piece of cake and Manythings comes swooping in with her concerns over Karen testing blood sugar and suggesting her xylitol & almond flour cake. Why is that?

Evelyn aka CarbSane said...

ManyThings -- I consider your comment offensive. Why do you assume Karen is being duped or something? I'm known her since 2009 I believe on Jimmy's forum. She lost weight and maintained it and has had her blood glucose under good control to the best of my knowledge. There is another long time reader and friend who has shared that nothing really got her blood glucose "fixed" better than good old fashioned ELMM and some weight loss. As Sanjeev points out, I've discussed many different ways that diabetes has been "cured" -- as in restored glucose tolerance -- here. Don't you think that IF it is possible, this should be the goal? There are also a number of low carbers who see worsening glycemic control over the years (Carpender and apparently Naughton come to mind). Healthy is not low insulin and low glucose. Healthy is good insulin signaling!

Your post here comes off as talking to Karen like she's a child and LC is the *only* way. Note she didn't say she's gone face down into bowls of pasta -- the "eye on carbs" part -- or thrown out her meter so as not to see the horrors of a piece of cake!

Congrats Karen on enjoying a piece of regular cake! Yay pancreas!!

Evelyn aka CarbSane said...

Yeah! What about that information was totally worth the pain (and cost?). Could have taken his wife out for a nice dinner for that.

Diana said...

I immediately looked up ketogenic diet and cancer on Pubmed and saw that. Of course, "with standard therapy" - so who knows what the real effect of the keto diet is?

I'm not against people talking about their personal stories and giving others hope. But the way Cantin (and Jimmy) frame it, it was the keto diet. There is NOTHING in his post about the lumpectomy and the drugs. I don't know about the podcast. I didn't listen. Can't take it.

Diana said...

Karen,

I hope you don't consider this piece of advice to be condescending - it is meant as anything but - watch the portion sizes sweetie!

I'm not diabetic, but I am a "sugarholic" (yes, Evelyn, I know you don't believe in the concept - wanna have an arm wrestle over it?), and former LCer who thought she had a "broken metabolism" yadda yadda, and when I began eating carbs oh so tentatively, I thought I was in heaven. I lost weight by being very fanatic about portion control. After a while, good old Guyanet-style food reward crept in and the portions became bigger...and bigger....

So all I'm saying is, the poison is in the dose. Carb/fat combos don't seem to have that self-limiting quality that pure carbs, pure fats, or proteins have, and I don't know why. They do seem to have some effect on the brain that says, a la Alice in Wonderland, "Eat me."

So enjoy your cake - but keep those portions tiny! Carb creep, feh - portion creep is very real.

Again - this is not meant in a condescending way. Just, "been there done that."

Regarding Manythings almond flour cake, I wouldn't touch that with a 10-foot pole for two reasons:

1. Almond flour is extremely high in fat, and not particularly good fats at that, according to anyone's definition. Not that I'm a fanatic about these proportions, just saying.

According to low carb guru, Richard Feinman, "dietary carb determines the fate of dietary fat" - one of the few things he's said which is true. Not surprisingly, he lifted the concept from Dr. J.P. Flatt, who did the research in the 1980s - carbs don't make you fat, it's their pairing with fat, in huge amounts, that make you fat, and keep you fat.

So cut down on fat. It's a soft target. This is one area I agree with the vegans AND the honest Paleoists. We weren't dousing everything with huge amounts of added fat until quite recently in human history.

Second, and I can't stress this enough, low-carb this and low-carb that encourage the unhealthy relationship with food that is so apparent on LC forums. People denying the reality of calories, guilelessly eating huge amounts of dietary fat (which will simply be put on as body fat) and being honestly mystified why they can't get below 240 pounds.

@Manything - don't bother denying that LC denies the importance of calories. It's a waste of your time. I've got two quotations, one from Attia, and one from Taubes, that destroy your positioin, so don't bother. The reason I am saying this is that denying calorie denialism is a standard tactic of LC dogmatists.

Lighthouse keeper said...

Yes I agree with most of what you are saying here Gabriella, in the UK also you only get about ten minutes with a GP unless your in serious trouble. My comment was more about the disregard for evidence based medicine and acceptance of pseudoscience as fact among some gurus of whatever persuasion. Your breakfast recommendations don't sound too bad to me, I used to eat grilled kidneys and liver for breakfast - in fact kidneys were a very popular breakfast ingredient in victorian England, now I eat mackerel or sardines on toast nearly every day.

Diana said...

"@Evelyn - I don't know why you've got such an attitude about what I said. What my friend does with her insulin is nothing to me. I was just commenting on the irony that George pointed out."

And I was responding by saying that he made a sweeping statement that requires some evidence before I assent to its legitimacy.

I have a confession to make. I am often intimidated by the science in these here parts. But when the subject is a little softer, and involves (to sound a bit pompous) the sociology of eating, I think I am an expert.

I am NOT diabetic but I've had my problems, and in my encounters with doctors, I have never been counseled by a doctor that medical treatments, medication, etc., is a substitute for common sense, healthy lifestyle choices.

George said, "all the cake you want" -- can you read, Dust Bunny?

Has any doctor ever said that?? I DON'T THINK SO.

So what is your point, Dust Bunny?

Many years ago, before the exercise boom, I begged a doctor for the magic weight loss pill of the day* and she refused to give it to me. What she saw was a moderately overweight woman who wasn't medically obese, but obsessed over fitting into nicer clothes. She refused. She told me to exercise. "It has no side effects," she said. I never asked her about portion sizes, but I expect that if I were diabetic, she would have told me to take my insulin and keep the portion sizes small.

Diana said...

*I forgot to put what the magic weight loss pill of the day was. It's the pill that's now on the market w/o script. It makes you poop your pants because you don't absorb dietary fat. I can't believe I would ever have begged a doctor for something as awful as that, but being desperate about weight does that to you.

Diana said...

@Evelyn, one more thing before I shut up.

THIS BUSINESS OF GUILT-TRIPPING DIABETICS MAKES ME FURIOUS.

I am hypothyroid. I take generic Synthroid. Conceivably, there are foods that I should avoid. I don't know - I've never researched it and I don't give a shit. I take my pill and I forget about it.

I am always going on gimmicky "last 10 pounds" diet and exercise programs, but that has nothing to do w/my thyroid, although I hope it results in improvement.

No one guilt-trips me about eating foods that may be "bad" for my thyroid. And if they did I'd tell them to fuck off.

So to the people who want to guilt trip diabetics for eating a tiny piece of something nice, and taking insulin, on behalf of the diabetic community, go fuck yourselves.

That goes double for a certain gluttonous fat man, who advocates that diabetics starve.

Evelyn aka CarbSane said...

A bit over the top language here, but I'm going to let it stand. I think you are venting many of the same frustrations I have. The science doesn't support LCHF as superior for all diabetics of any stripe. It's time for the low carbers to recognize that and stop shouting down anyone who dares try a lifestyle that works and makes them happy. If that's LCHF great! But if it's not ... how about be happy for them too, eh?

Since you mentioned thyroid, I bring up that analogy often, and it's odd how many low carbers are hypothyroid and need to take more of their medications on their LC diets. Just an observation.

Evelyn aka CarbSane said...

PS Anyone read Jimmy's latest 1000 Pictures post with the sanctimonious commentary interspersed throughout? There are studies where OJ has been shown to be tons different than a Coke. I was reminded of the Frasetto "10 day paleo miracle" recently and the 10 days of iso-carb (including pineapple and carrot juice and tomato soups) was preceded by a 1 week "ramp up" with lots of OJ. So it's maddening that this guy keeps going on (and is going to be writing a book on cholesterol!)

Gabriella Kadar said...

@ Lighthouse keeper: evidence based medicine is a bit problematic at this time. For the past while it has been promoted as THE way to do things. However, it has been recognized that treatments which work and have been used in the past have been discarded because the new focus on 'evidence based' can't elucidate why they work.

Pre-evidence based medicine would be the use of antibiotics (tetracycline) prior to the 1960s for treatment of peptic ulcers. Then in the 1960s it was decided that peptic ulcers are caused by psychological stress. Well, 1995 we've got H. pylori and the accepted and standard treatment for peptic ulcers is once again antibiotics. Just think of all those poor people shoveling in the Gaviscon and Gelusil because their problem really started in their minds and only ant-acids would reduce symptoms.

Evidence based medicine has gone to the point of relying on molecular proofs. The mechanism of action is sought before anything is considered to be valid. Imagine how long it would have taken to get a vaccine for small pox or polio.

I suppose we now have two extremes: the alt-med group and the molecular scientist group. Neither is really serving the population all that well. It means that new medications and treatment protocols are beyond the pocketbooks and economies of most people and countries. And then we have the internet gurus who promote supposedly efficacious 'treatment strategies' that have little or no observational studies to support their use.

Gabriella Kadar said...

But a diet with lots of potatoes would at least provide a lot of potassium. Dude's diet probably is deficient. I would query magnesium as well. The vitamin pill won't make up for these.

Gabriella Kadar said...

Eventually they'll go blind and won't be able to read all the internet guru rubbish. They'll be going for dialysis three times per week which will occupy a huge amount of time seeing as probably they'll have had their feet amputated due to gangrene and won't have too many exercise options. They may even consider committing suicide with bananas.

Gabriella Kadar said...

Evelyn, possibly low carbers have worse hypothyroidism because most carby foods require salt (iodized) for palatability (potates, pasta, rice).

I've been thinking recently about why Synthroid is the number one (based on prescriptions written) in Canada. It's perturbing. Number one in the USA is hydrocodone. That's perturbing too but in a different way.

Gabriella Kadar said...

Diana, if you are on full replacement dosage with thyroxin and your thyroid is doing nothing, then I don't know of any dietary recommendations to prevent problems with the thyroid.

Functional thyroids are not supposed to be hammered with high iodine or selenium intakes. As far as I am aware, that's all.

Woodey said...

This is a big part of the sales pitch that you will find in the LC/Paleo movement (or any group trying to make a buck) and it really is selling false hope to people. Cults do this, claim they have a cure and if you stray you will inevitably fall prey to your worst fears. When I was on Paleo Hacks a long long long time ago, I saw posts where people talked about not trusting their doctor and instead wanted to get advice from the regular stiffs that post on the forum. The Fathead group in Facebook is the same way, doctors and scientists are evil and paid off (unless Tom aka Dickhead agrees with them), his blog site as well as FB site is full of that kind of nonsense.

I've said this before and I'll say it again; these jerks will promote whatever they need to in order to get people to listen and spend money. It's easy to talk big crap when you are safe at home sitting on your big butt eating whatever, but it’s a guarantee that these same nutritional hacks will go to the doctor if something serious happens to them. If one of these "my weird diet fights cancer" promoters actually gets cancer...they are not going to take some B vitamins, eat a steak and hope for the best...their butt is off to the doctor for whatever treatment it will take in order to live.

This is why I will be merciless in how I speak or treat these people. Last time I saw Rob Wolff post in here I called him the "feces whisperer". They are cultivating an atmosphere of fear in hopes to be able to make a living from it. Well meaning people who are putting their trust, nay, their lives in these false prophets’ hands are really endangering themselves. I despise these people and hope they burn, I really do. I hope they get hit with a lawsuit or something severe so that they shut up and go away...unfortunately the downside is there are always 10 jerks waiting to replace the one.

I know people complain about Carb spending too much time on the actions of these people, but it is necessary to do so. You have to establish how corrupt these people are to begin with, in so doing you help cut through the bunk and show that their doctrine is merely an extension of their corruption.

Melissa Mcewen said...

One of my best friends is a type 1 and she does not just eat cake willy nilly. She has it once in awhile, but overall she eats a prudent moderate diet without any junk food high in added sugars. I think most doctors would recommend such an approach, but they know many patients, especially those with juvenile diabetes, might not be so compliant.

Woodey said...

"I'll stick with my insulin, a healthy mixed diet with some exercise and have every hope of being around for a good few years yet."

That's all you can and really anyone who is diabetic can do, which is great. Even for people who aren't diabetic a nice balanced diet with some exercise is perfect. There is no magic bullet for anything and I have come to grips with that. Who knows how I will die, eventually something will shut down in my body regardless of diet, but I can sure do something about the quality of how I live until then.

The past few months I have gone to the balanced diet/exercise approach and have lost weight and feel really good. I recommend that lifestyle to everyone who is capable to do so.

Woodey said...

I agree with Nigel. I would be miserable on such a diet, it's obviously meant to be a short, lets take a look at something diet. I would eventually go over the calories in that diet. My body would start craving real food and I would go binge on steaks, bacon, anything that would offer my body something other than nutrient lacking food. This would then put me over the calories needed and I would start to gain weight.

I believe calories do count, but that the body will direct you to what it needs to be satisfied. I find for myself that if I don't listen, my mind eventually wins and I binge. I eat more than I need and get larger. I did that on the LC diet numerous times with my sugar cravings. On Weight Watchers I eat a lot of fruit and have noticed that the sugar cravings are virtually nonexistent,hence my body is satisfied and the binges are gone.

Something has happened to my body where as long as I eat regularly and with variety my desire to eat sweets as well as over eat is all but gone.

Unknown said...

The one that I can't forget is "I'm feeding my young children a low-carb diet but they are hungry all the time, what am I doing wrong?"

Diana said...

@Evelyn - My language *was* excessive. I promise: never again. But I got so enraged at the study Josh cited about the poor diabetic kid who was willfully starved to death. Juxtaposed that with Jimmy's thoughtlessly saying doing so is "prudent." Check his blog. Which he has scrubbed - yet again. He removed my comment. And his stupid reply.

Diana said...

@Gabriella, I know. I mention it because it is a subject I'd seen discussed (with the usual lack of rigor) on LC sites. Soy is usually cited as a malefactor. I don't eat soy it is irrelevant to me.

Diana said...

Just curious, Woodey - do you find that sweets are esp. tempting during certain times of the year, such as Christmas (or birthdays, or any kind of celebration)? I do, and I don't even celebrate Christmas.

Diana said...

Jimmy Moore should be forced to read this study 10 times, and then forced to write, "I will not say that starvation is 'prudent' ever again" on the blackboard 1000 times.

Diana said...

@Woodey and Evelyn (and everyone else), The real scandal here is the MDs and PhDs who go on Jimmy's podcast and give him the veneer of respectability that he parlays into sales. Feinman is an obvious example.

But what about Thomas Dayspring, a respected lipidologist? The mind boggles.

Being associated with the the man who didn't know who David Duke was is bad enough. Now he is retroactively associated with a man who advises diabetics starve, and who shills for a woman who claims her cancer was cured by a keto diet!

Charles Grashow said...

http://www.nutritionj.com/content/10/1/23
Why were "starvation diets" promoted for diabetes in the pre-insulin period?

As to Dr Dayspring - didn't he tell Jimmy that if his LDL-P didn't drop below 1000 he would advise starting statins?

Sandy Daigler said...

As I read this post and all its comments, what strikes me is how hard it is for the average person (like me) to know what's good information and what's trash. I get most of my nutritional information from my nutritionist, whom I pay the full cost to see because my health insurance company "does not cover nutrition-based therapies" (this is a quote from the benefits determination statement I get everytime I see her). I'm lucky I can afford to pay the full cost. I've never had a doctor tell me the kind of things my nutritionist tells me -- is that because they didn't know or because they couldn't fit it into the 10 minutes they can spend with me? But I continue with her because it's a source of information that can be trusted to keep my weight down without killing me.

Gabriella Kadar said...

If I've forgotten to eat breakfast _and_ bring food to work, it's 3 or 4 p.m. and there are cookies from Christmas hidden in the bottom drawer of the stationaries cupboard, then I turn into a human vacuum cleaner. Other than that, the cookies stay hid. ;) Other people know where they are stashed and the attrition is alarming. Only a good West Indian 'tshup' expresses what I feel when I go hunting (and gathering) only to discover that only those gingerbread windmill cookies are left. ;0 Mostly it's best to not tempt the devil. Out of sight, out of mind.

Woodey said...

@Diana - I do to a certain extent, but I believe it has more to do with a learned behavior than something innate. I did notice that the holidays this year were not much of a struggle with temptation, I allowed myself to eat some sweets, but for the most part I didn't over eat or eat anywhere near what I normally do.

Gabriella Kadar said...

Sandy: both. How long is an appointment with your nutritionist? You could just for the sake of curiosity ask your physician's front desk person to fill out an insurance predetermination for nutritional counselling provided by your physician and find out if this is a covered benefit.

I think it is a very cost effective and sensible thing for a person to attend appointments with a good nutritionist. We need teamwork because no one person can be everything for each patient.

eulerandothers said...

Diabetes reversal? I'm thinking Counterpoint!

http://www.ncbi.nlm.nih.gov/pubmed/23075228
'It has become widely accepted that type 2 diabetes is inevitably life-long, with irreversible and progressive beta cell damage. However, the restoration of normal glucose metabolism within days after bariatric surgery in the majority of people with type 2 diabetes disproves this concept. There is now no doubt that this reversal of diabetes depends upon the sudden and profound decrease in food intake, and does not relate to any direct surgical effect. The Counterpoint study demonstrated that normal glucose levels and normal beta cell function could be restored by a very low calorie diet alone.'

http://www.ncbi.nlm.nih.gov/pubmed/23320491
'Following publication of the Counterpoint Study (on the reversibility of Type 2 diabetes using a very low energy diet), the extent of public interest prompted the authors to make available, on a website, general information about reversing diabetes. Shortly thereafter, individuals began to feed back their personal experiences of attempting to reverse their diabetes. We have collated this information on the effects of energy restriction in motivated individuals with Type 2 diabetes that has been achieved outside a research setting.'

http://www.ncbi.nlm.nih.gov/pubmed/21656330
'Normalisation of both beta cell function and hepatic insulin sensitivity in type 2 diabetes was achieved by dietary energy restriction alone. This was associated with decreased pancreatic and liver triacylglycerol stores. The abnormalities underlying type 2 diabetes are reversible by reducing dietary energy intake.'

Woodey said...

@Sandy - Hello, I am in the same boat as you are when it comes to understanding a lot of the in depth information in regards to nutrition. I do promote talking to nutritionists; people with a degree in a specified field are going to be more knowledgeable than some clown promoting releasing their inner animal. If I had known more about nutrition I wouldn't have gotten into LC/Paleo and avoided it. I find it hard for me to always spot the bunk, which is why I like coming here.

The best advice I can give is to continue to listen to the nutritionist, ask them for a book or two that will give you general nutritional information and follow your common sense radar. Unless you have an illness that requires a specific diet, you more than likely know enough already to eat and live well. Another thing I have done is cut myself off from the majority of the information that is fed to us. General rule of thumb I have: if I don’t know enough to spot the crap, then I am better off to avoid it all together and move on. Having a reliable person who can help me out is also very valuable. If I was you I would write down questions you have and bombard your nutritionist at every session.

One reason a doctor might not give you the information your nutritionist did is because it’s not his/her specialized field. My guess is the doctors we go see for checkups, shots, and the like have only taken a couple of nutrition classes while in college, more than likely one of them was for clinical nutrition and the other general. I'm fairly positive that other classes such as biology and chemistry also tied in with some of what was learned in nutrition as well, making them more knowledgeable. Since it’s a specialized field of study, nutritionists get more courses on nutrition as well as additional training, seminars, and updates during their career. Bottom line is they know more than the general doctor on this subject.

Sarra Bess said...

One reason a doctor might not give you the information your nutritionist did is because it’s not his/her specialized field.

I'd like to emphasize this. I'm a microbiologist (PhD, not MD) and work closely with a number of infectious disease specialist MDs. Not only would none of them ever give nutrition advice, they would never give medical advice for anything outside their specialty, e.g., cancer or diabetes (other than how they interact with/are affected by infections and antimicrobial medication). Doctors specialize for a reason; it's because the body of knowledge in any one area of medicine is so large a practicing physician is lucky if she can keep up with what's in her field. Keeping up with advances in other fields is impossible. Doctors are not qualified to give anything but the most general medical advice in any area outside their specialty.

It is frustrating that many insurance plans don't cover nutritional counseling, given how important it is. However, you might consider asking your physician if there is a referral system wherein a referred visit to a nutritionist would be covered; some medical plans have that loophole. Some medical plans will also cover nutritional counseling if it is for "disordered eating"; it all depends on the code your nutritionist puts down on the billing statement. You might ask your nutritionist or your insurance agent if your insurance covers those exceptions.

Dustbunny said...

Diana, you said you didn't believe there were such people who did that with there insulin. I commented that I know someone who did. It's as simple as that. Geez, you people are rude.

Dustbunny said...

He certainly is obsessed with his diet. What a horrible way to spend a week.

Dustbunny said...

I really think it's dangerous to put up stories like that, cancer being cured by a keto diet. If curing cancer was that simple, you'd think doctors would prescribe it instead of chemo and radiation. JM is wrongly giving the idea that you can stop the chemo and radiation and just eat a keto diet. They'll just die a lot sooner than later.

Diana said...

"Diana, you said you didn't believe there were such people who did that with there insulin. I commented that I know someone who did. It's as simple as that. Geez, you people are rude."

Dustbunny, I was responding to George's blanket condemnation and sweeping statement, not to your "my friend does this". Apparently you don't understand the difference between the two.

Here's a little schooling. Women are shorter than men. My friend Julia is 6'2". My friend Paul is 5'4". Geddit?

Rude? You have no clue.

Diana said...

@Woodey, "@Diana - I do to a certain extent, but I believe it has more to do with a learned behavior than something innate." That's my point. I tend to crave desserts more at certain times than others. I believe those time have to do with outside stimuli than anything innate. My point being that the definition of "free living human beings" means something we should be thinking about more carefully.

For example, Taubes loves to talk about "working up an appetite." I happen to sort of agree with Taubes about exercise - up to a point. I do think that if you work a hard manual labor job, it will make you hungry. An empty belly is an empty belly no matter where you are from!

But - and this is quite important, maybe an American working man will fill his empty belly with 2500 calories of 40% fat food, whereas an Indian low-caste laborer will be happy with 1000 calories of 20% fat food....etc. It's what we are taught, which depends upon what is available.

Human eating is a learned habit. I don't disdain what we learn from mice - but it may not mean so much in terms of weight loss. What means something is the difference between eating 1000 calories and 2500 calories.

Lighthouse keeper said...

The word nutritionist has been used several times above, in the UK it is not a regulated or protected profession meaning anyone with a dodgy mail order degree could start up a practice unlike the profession of Registered Dietitian for instance where certification is legally required. Is it not so in most US states also?

Sarra Bess said...

"Nutritionist" and "nutritional counselor" do require certification in the US, but the certification is relatively easy to come by. Most nutritional counselors associated with legitimate medical practices are actually RDs. However, almost no one refers to RDs as RDs in common parlance, they're generally called nutritionists, even though that is technically inaccurate. My comment above was certainly referring to RDs.

Beth@WeightMaven said...

This list shows which US states require licensing or certification for nutritionists:

Alabama (1989)* - licensing of dietitian/nutritionist
Alaska (1999) - licensing of dietitian/nutritionist
Arkansas (1989) - licensing of dietitian
California (1995)* - registration* of dietitian
Connecticut (1994) - certification of dietitian
Delaware (1994) - certification of dietitian/nutritionist
District of Columbia (1986) - licensing of dietitian and nutritionist
Florida (1988) - licensing of dietitian, nutritionist and nutrition counselors
Georgia (1994)* - licensing of dietitian
Hawaii (2000)* - certification of dietitian
Idaho (1994) - licensing of dietitian
Illinois (1991) - licensing of dietitian and nutrition counselors
Indiana (1994) - certification of dietitian
Iowa (1985) - licensing of dietitian
Kansas (1989)* - licensing of dietitian
Kentucky (1994)* - licensing of dietitian and certification of nutritionist
Louisiana (1987)* - licensing of dietitian/nutritionist
Maine (1994)* - licensing of dietitian and dietetic technician
Maryland (1994)* - licensing of dietitian and nutritionist
Massachusetts (1999) - licensing of dietitian and nutritionist
Minnesota (1994) - licensing of dietitian and nutritionist
Mississippi (1994)* - licensing of dietitian and nutritionist title protection
Missouri (1998)*-certification of dietitian
Montana (1987)* - licensing of nutritionist and dietitian title protection
Nebraska (1995)* - licensing of medical nutrition therapists
Nevada (1995)* - certification of dietitian
New Hampshire (2000) - licensing of dietitian
New Mexico (1997) - licensing of dietitian, nutritionist and nutrition associates
New York (1991) - certification of dietitian and nutritionist
North Carolina (1991) - licensing of dietitian and nutritionist
North Dakota (1989)* - licensing of dietitian and certification of nutritionist
Ohio (1986) - licensing of dietitian
Oklahoma (1984) - licensing of dietitian
Oregon (1989) - certification of dietitian
Pennsylvania (2002) - licensing of dietitian-nutritionist
Puerto Rico (1974)* - licensing of dietitian and nutritionist
Rhode Island (1991)* - licensing of dietitian and nutritionist
South Dakota (1996) - licensing of dietitian and nutritionist
Tennessee (1987) - licensing of dietitian/nutritionist
Texas (1993)* - licensing of dietitian
Utah (1993) - certification of dietitian
Vermont (1993) - certification of dietitian
Virginia (1995)* - certification of dietitian and nutritionist
Washington (1988) - certification of dietitian and nutritionist
West Virginia (2000) - licensing of dietitian
Wisconsin (1994) - certification of dietitian
*Indicates year amended or reauthorized under sunset provisions.

I'm sure the difficulty for certification varies. In Pennsylvania, certification is NOT "relatively easy" to come by.

Lighthouse keeper said...

Thank you Sarra, quite a few comments above used it not just yours. There are a few so called obesity researchers, diet gurus etc around who use it as a credential without any valid qualifications gained or who have yet to even begin a course and then make claims decrying the eating of fruit and vegetables.

Diana said...

His weight loss seems to have stalled. Jan. 8th he weighed 245, Feb. 1, 243. 85% fat intake will do that to ya.

Jason Sandeman said...

Wow. the quote reversalis nothing more than the honeymoon.
so let's see what the kid looks like after a year or so of not taking any insulin. It's a common problem newly dx diabetic mistake. The worst part is that the kid will speed up the destruction of his pancreas and require more. This is the voice of reason. The community will ostracize you for suggesting it though

Dustbunny said...

Thank you, ma'am. I appreciate that you care enough about me to provide a little schooling.

coconutz said...

Looks like the Keto train has gone off the rails.

Unknown said...

The contrary argument is that having no education or training in medicine or science makes one uniquely qualified to challenge the establishment with an outsider's perspective, take for example my paper on the ventrilation of oxidative diametrical radicals in the LN5 lipatoid stress response, it brought the establishment to its knees.

Diana said...

Actually he's been stalled now for a full month. I went and looked again - he was hovering around this weight by early January. This probably accounts for his more than usually aberrant behavior now, the obsessive weight-checking, the hourly finger-pricking, etc.

Diana said...

I guess that's the rationale for Jimmy writing a book on cholesterol. I wonder if he has a book deal, or is he just writing it and intending to shop it around?

Charles Grashow said...
This comment has been removed by the author.
Charles Grashow said...

does he??

"This has been an odd week for me because my “normal” schedule of blogging, podcasting and social media stuff will be shifting to a much more intense book-writing mode starting next week and for the next couple of months or so. I’ve been researching and preparing the general outline of my upcoming Victory Belt book about reading cholesterol test results and the nitty gritty of typing it all out in an easy-to-use layman’s guide to understanding it all begins in earnest next week. I’m truly excited about this project and everyone I talk to says this is the kind of book that is needed now more than ever. The expected release date will be sometime in the Fall 2013 (likely September or October) and it will be listed on Amazon by March for pre-orders."

http://victorybelt.com/
Victory Belt Publishing Inc is the world’s leading publisher in health and fitness books, producing a host of New York Times bestsellers, including The Paleo Solution, Practical Paleo, It Starts with Food, and Dark World. Started by Erich Krauss, a New York Times bestselling author, Victory Belt Publishing Inc is an author-friendly publisher geared toward producing the highest quality books on the market. Victory Belt Publishing has worldwide distribution, and its titles have been translated into dozens of languages. The company has the highest ratio between books published and New York Times bestsellers. Victory Belt Publishing‘s main office is located in Las Vegas, Nevada.

http://victorybelt.com/contact-2/
Victory Belt welcomes new book proposals for publication. We accept submissions directly from authors and from literary agents. It’s helpful to familiarize yourself with our catalog and/or similar books that we publish to determine how your proposed book fits into our list. Our submissions team makes every effort to review proposals as they are received, but in some cases, it can take a few few weeks before weare able to fully discuss and respond. If you wish to submit a project for consideration for publication, please send a complete book proposal consisting of:

A letter describing the work as a whole, including information on what makes your manuscript unique and how it contributes to its field
The table of contents and introduction
A description of the target audience for your project
A brief biography of yourself, please note any special qualifications for writing about your subject
If available, please include one or two sample chapters that give a sense of the project’s scope and your writing style.

coconutz said...

JM comment

"Since the holidays, I've stepped up my weight lifting again and presume it's muscle gain. I'm getting another DXA scan done this week, so we'll see."

2-20 minute weight lifting sessions in 7 days. 1 hour frisbee.

I can't wait for his book on Nutty-K fitness.

Hey JM, if your reading this.

How about doing an N=1 where you actually move every day, like walking for 30 minutes maybe a few pushups and situps to boot. I know, not Paleo right...

Charles Grashow said...

http://gokaleo.com/?p=1029

"Low-carb is a band-aid solution to the metabolic dysfunction caused by inactivity. The human body requires regular physical activity to remain metabolically healthy. When the body is metabolically healthy, it can metabolize carbs (and fat and protein) just fine.

Metabolically healthy people do not need to be on macronutrient restrictive diets. Metabolically dysfunctional people may need to follow restrictive diets, but their long-term goal should be to return the body to healthy metabolic function, and the primary way to do that is regular physical activity."

coconutz said...

your, should be you're

Charles Grashow said...

From Go Kaleo

"Many of the prominent low carbers are still struggling with metabolic issues and obesity despite sometimes years of low carbing. And by it's very definition, low-carb is designed to mitigate the symptoms of metabolic dysfunction, namely blood glucose dysregulation. If a person must eat low carb to control their blood sugar, then they don't have healthy metabolic function, and their diet hasn't successfully treated their condition, only mitigated some of the symptoms."

HappyHappyJoyJoy said...

Quote from above from the LLVLC show notes:

But I think I am more bothered by her son's type 1 diabetes. From the show notes:
Her son was diagnosed with Type 1 diabetes and hospitalized
He experienced having a lot of ketones while he was sick
This enabled him to come off insulin for a few days
Starvation actually produced an adequate amount of ketones
You can replace starvation ketones with a ketogenic diet
How her Type 1 diabetic son is doing on ketogenic diet
She did test her diet on her son and he didn’t need insulin

Here's my worry: I grew up in a religion that believed in faith healing instead of doctors. And when kids died, parents were legally and criminally liable. That was just the fact of the matter.

As a parent, you really need to consider this.

When you buck the traditional medical system, not only do you perhaps cause injury (or worse) to your child, you are now in criminal trouble. I wonder if this woman realizes the potential horrific problems she could have doing this with her son - not only his health (which would be devastating should he pass) but her potential to be charged criminally.

Not only that, now this is being spouted as something others should do - and that really scares me.

Thanks again, Evelyn, for pointing out another problem in this community.

Liberrocky said...

"It is the KETONES! Which does not mean that mild ketosis is dangerous, but diabetic ketoacidosis is what kills diabetics and it is due to very high levels of fatty acids that are converted to ketones."

It's not the ketones that cause the problem in diabetic ketoacidosis it is the glucose not being cleared.

But of course "When I read stuff like this I wonder if people in the LC wing of the IHC have any clue what the real problem is in T1."

Uh huh.


Diana said...

"please note any special qualifications for writing about your subject."

The only qualifications JM has for writing a book about cholesterol would be if the book were named HOW TO RAISE YOUR BAD CHOLESTEROL AND GIVE YOURSELF KIDNEY STONES IN 240 DAYS.

What's the opposite of "l'chaim" (to life)?

coconutz said...

Probably stress related due to writers block, LOL.

Gabriella Kadar said...

The opposite of 'l'chaim'? That would be a curse. Strictly not a good idea. But you may spit in his general direction if it makes you feel better. ;)

Diana said...

That's not what I meant (spitting in his direction). I wish him no ill. He doesn't need my ill will; he does himself enough harm as it is.

What I meant was, whatever he practices is the opposite of "to life." What this guy does brings on ill health and body dismorphia. Weighing yourself constantly, taking measurements of this and that, is crazy. No way to live.

Evelyn aka CarbSane said...

It boggles the mind that there would be any advance or contract. Or that VB approached him as he's described this. His first book was self published (nothing wrong with that) but the second was supposed to be published. However I recall the publisher backed out and he ended up self publishing it as well.

George Henderson said...

I should also have mentioned the price of insulin in the early days and the short supply meant that low-carbing was maintained.
Have you seen this recent paper on accuracy of carb counting with DM1?

http://www.diabetesresearchclinicalpractice.com/article/S0168-8227(12)00391-9/fulltext

This is also interesting - UK the sugar industry's position.

http://www.sugarnutrition.org.uk/Diabetes.aspx

The old idea that sugar causes diabetes was dismissed as long ago as 1989 by the UK Government’s COMA Committee (DoH 1989) . The FAO/WHO Expert Consultation on Carbohydrates in Human Nutrition reiterated in 1998 that sucrose, and other sugars, do not cause diabetes. The evidence available since these consultations does not merit any revision of that opinion (ADA 2008, Diabetes UK 2011). Furthermore, despite diabetes being a condition of blood glucose regulation, specific restriction of sugars is not necessary, except to ensure a balanced diet.
Achieving and maintaining a healthy body weight through diet and physical activity is of the utmost importance. Foods high in fat, which might predispose to obesity, are not encouraged, even though they might appear to have an advantage in not raising the level of glucose in the blood rapidly. Overweight individuals with diabetes should be encouraged to reduce their energy intake, by decreasing their dietary fat intake, and increase their physical activity levels, as even a modest weight loss (5-10%) will improve blood glucose control and other metabolic abnormalities associated with the disease. Research has shown that a weight loss of 10kg can reduce the risk from diabetes-related deaths by about a third.

Sanjeev said...

> "Low-carb is a band-aid solution to the metabolic dysfunction caused by inactivity. The human body requires regular physical activity
__________
IOW,

"all the biochem I need I learned watching WALL-E"

blogblog said...

It is illegal (or at least unethical) in most countries a medical doctor to treat a patient without examination. However it NOT illegal or unethical to give general medical advice.

It is NOT illegal or unethical in most countries to give dietary advice.

It is illegal in many countries to treat CANCER patients unless you are a registered Medical Practitioner (MD).

Unknown said...

When I was spectacularly unhealthy walking 30 minutes was an ordeal.

I don't care how many times you prick yourself if walking 30 minutes is too much for you then you are a mess.

Laura Semmens said...

Good God, he is totally unrealistic about how hard it is to put muscle on, especially since he has low testosterone. And 40 minutes a week sure isn't going to do it. "Gaining muscle" when weight goes up or stalls is always the refuge of the overeater.

Diana said...

@Laura, absolutely! I have looked up the studies - even fit young men don't put up lots of muscle in absolute terms -

http://arno.unimaas.nl/show.cgi?fid=6819

Check out Table 2.3. Absolute numbers of muscle mass gain are very modest, and these subjects are fit young men. Perhaps an unfit man might put on more muscle because he is starting from a lower base, but not much more.

Of course he is fooling himself. And I think he knows it, as this constant weight checking indicates. He's been weight stable for

Most of the weight normal men I know never check their weight - some don't even know exactly how much they weigh. When the suit gets tight, they cut back. This, to me, is normal in a guy. Constantly weighing yourself is aberrant behavior.

Diana said...

Oops... he's been weight stable for two months.

Charles Grashow said...

For all of the glucose testing that Jimmy and his minions do - how accurate are the results?

A device could receive FDA approval if it could measure accuracy to within 20% of the actual blood sugar value as determined by a laboratory machine. For a blood sugar of 200 mg/dl (11.1 mmol/l), the home device could give you a value anywhere between 160 and 240 mg/dl (8.9 to 13.3 mmol/l). That doesn’t exactly inspire confidence, does it?

http://bionimeusa.com/files/journal_papers/IDT_Report.pdf

http://www.ndr.de/ratgeber/gesundheit/infektion_immunsystem/testmessgeraete101.pdf

Charles Grashow said...

http://www.maoritelevision.com/default.aspx?tabid=75&pid=15760&EPID=34080

The Native Diet is a factual TV programme series that challenges a group of participants to eat and exercise like their tupuna in an effort to have a healthier body and mind.

Effectively paleo + Crossfit for modern urban Maori who, like so many indigenous peoples, are over-represented in poor health statistics. No geo-restrictions, so everyone is free to watch it.

Charles Grashow said...

http://thatpaleoguy.com/2012/12/24/calorie-rants-and-ketosis-part-2/

Go about halfway down - interesting take on nutritional ketosis

Start here
"I want to shift my attention to ketosis as it seems to have replaced intermittent fasting and cold water thermogenesis as the latest hot-button topic in the paleo blogosphere. My executive summary is that nutritional ketosis is a tool, it isn’t for everyone (it may well only be for a select few), and that people really need to do their homework (which includes taking a long hard look at themselves) before they dive down that rabbit hole."

Liberrocky said...

@Emily & @Diana

Here is Eugene Fine's small (and short) study that shows promise with various types of cancer:

http://www.ncbi.nlm.nih.gov/pubmed/22840388

Key points:

"In nine patients with prior rapid disease progression, five with stable disease or partial remission on PET scan after the diet exhibited a three-fold higher dietary ketosis than those with continued progressive disease (n = 4, P = 0.018)."

"The extent of ketosis, but not calorie deficit or weight loss, correlated with stable disease or partial remission."


@Emily
"As for tumors in the rest of the body, I'm not so sure. Blood glucose doesn't drop below a certain amount due to gluconeogenesis for a reason."

And regarding gluconeogenesis there studies that show positive results when using metformin as an adjunct.

I think that holding blood glucose very low may place cancer cells under enough stress that their ability to divide and metastasize is reduced.

I would love to see a study that combines a ketogenic diet with metformin.

Diana said...

The Maori weren't Paleolithic. This Paleo imperialism has got to stop.

Diana said...

"ketogenic diet with metformin"

What are the ethical issues with such studies? I'm a total amateur. But I've heard that when things are shown to work (or to be disastrous), you stop the study. That leads to people asking whether it worked at all.

Correct me if I'm wrong!

Charles Grashow said...

http://scienceblogs.com/insolence/2013/01/30/dr-ozs-journey-to-the-dark-side/

"After having subjected myself to this latest atrocity against science by Dr. Oz, I now think that he’s finally jumped the shark. Actually, he jumped the shark long ago, when he featured Dr. Mercola on his show, but maybe this will be will be a wake-up call in which Oz does something so utterly ridiculous, so devoid of anything resembling science, that perhaps people will start to realize that Dr. Oz is no longer a doctor who cares the least bit about science or even whether a treatment he features on his show works. After all, if he would promote magic water on his show without featuring even a shred of credible evidence that it does what he claims it does, Oz has forfeited any claim to be a credible scientist or science-based physician. In fact, so perfunctory is this show, so reliant on Oz’s charisma and appeals to authority coupled with the bandwagon fallacy in lieu of evidence, that I wonder if Oz is even trying anymore. It’s like he’s phoning it in."

Evelyn aka CarbSane said...

His weight fluctuates like a premenstrual woman's! Even at his weight, a couple pounds day to day is normal unless you are really doing something drastic with food. Jimmy has always gained or lost several pounds -- like 8 once I think!, but 5 or so not uncommon -- in a day. Taken with his urine crystals and protein, it sounds like his kidneys may be in pretty bad shape.

Lighthouse keeper said...

A good example of why it is best to look to the body of scientific evidence rather than high media profile individuals if you need some light rather than hype.

Sanjeev said...

Charles, Oz is a proverbial Tie fighter conducting skirmishes from his base, the "Death Star of health", Oprah.

In this allegory/satire Deepak chOPRAH is Palpatine. They seem all of one piece, back to the time long ago that Oprah invited Randi and he was edited to ineffectualness.

Dr. Novella went on Oz a while ago too, to discuss alt-med and the details are gone from my memory ... Steve expected to be edited down an was but not as badly as he had expected (IIRC).

This is a long-standing tradition/pattern with this subculture. I was going to write triumvirate, but if you include all the other outlets that trace their web to Oprah it's a hive.

Sanjeev said...

> back to the time long ago

unfortunately NOT in a galaxy far, far away ...

<cue John Williams>

blogblog said...

Unfortunately I've had more than my fair share of dealings with the medical profession over the years. To be blunt medicine is nothing more than a skilled trade with a superficial veneer of science (hence the white coats).

The Soviets in their wisdom decided that medicine was mostly quackery. They paid physicians what they were actually worth (very little) and sent their best students to study engineering and the physical sciences.

OnePointFive said...

@ Liberrocky

The acidosis isn't caused by high glucose levels per se. There is a very serious condition with high glucose levels and no ketones.(often called HONK hyperosmolar non-ketotic coma) It's insidious and a problem often experienced by elderly type 2 diabetics. They have enough insulin to suppress lipolysis and ketone formation but not enough to lower the glucose levels.

The acidosis in DKA is caused by the proliferation of ketones which lower the pH of the blood;(pH below 7.3). It can occur very rapidly.

It's the lack or relative lack of insulin that causes the runaway production of ketones(insulin acts as a 'brake' in non Ds. Insulin requirements are also increased when ketones are present)
It's undoubtedly normally accompanied by high glucose levels but not invariably. There are times when people get DKA with relatively normal blood glucose levels most usually when they've been vomiting(or starving themselves. It can occur in pregnancy and I have read of that children in the developing world can normal glucose levels and DKA at diagnosis )
brief review of the condition on youtube .
paper mentioned
Starvation-induced True Diabetic Euglycemic Ketoacidosis in Severe Depression
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2607495/

Simon Carter said...

Yes, that really worked out great for the Soviets.

Diana said...

"The Soviets in their wisdom" that, plus "menstruation is completely abnormal" comprise blogblog's greatest hits.

Half of the Russian immigrant women I've known were "engineers" back in the old country. They were forced into it. They all hated it. Not one worked as an engineer in the US.

The happiest Russian woman I knew worked as a sec'y for a couple of years before opening up her own beauty shop. I've never met a woman who loved cosmetology more than this former civil engineer.

river rance said...

" I’m truly excited about this project and everyone I talk to says this is the kind of book that is needed now more than ever."
Name names Jimmy, who is everyone? Robb Wolf? Mark Sisson? David Duke? Eades? Who is going to review the book and give a link to purchase? David Duke et al?

Princess Dieter aka Mir said...

That small snippet makes me weepy. Thinking about the kid so starved that...omg. My heart hurts. :(

Princess Dieter aka Mir said...

Any time you're doing something this obssessive, not to mention eating a diet that is just totally unrelated to how mankind has eaten in any normal context, historical or current, it's time to take a look at oneself. Just stop and assess and get a grip. And I do not say that cruelly, meanly. I mean that this is just not "well". Maybe Jimmy sees this as science. Man and his own glucose frontier. I see it as unhealthy...and sad.

Princess Dieter aka Mir said...

Jimmy is writing a book to explain cholesterol tests? The guy who disregards the scary-high numbers on his own results? Oh, lawdy.

Unknown said...

For those interested I am starting an Email "Meal Plan" subscription service for the price of $9.99 per month.

Basically each week I will send you a link to the local supermarket's weekly specials, which you can then use to plan your meals, assuming you live near that supermarket.

The first 15,000 subscribers will receive a 25% discount for the first month's service.

Charles Grashow said...

http://gokaleo.com/?p=1033

"Cognitive Dissonance is a very uncomfortable state to exist in, and people have all sorts of ways of rationalizing it away. When one is deep, deep in the dogma of a dietary philosophy, evidence that someone has succeeded by doing things they have been indoctrinated to believe are ‘unhealthy’ or ‘make you fat’ can cause agonizing dissonance and confusion. If you are having that experience right now, I invite you to spend a little time in those feelings. Really explore them with a critical, rational mind. Maybe it’s worth questioning your dogma, especially if you’re frustrated or feeling like you’re not having the results you’ve been promised.

I am here to tell you that there is no magic anything. There is taking responsibility for the behavior that has created your problems, and there is doing the work necessary to change that behavior and create new habits. No ridicule or excuse will take away the cognitive dissonance. No amount of ridiculing me or making excuses for my success will take away the fact that I succeeded by creating new, healthier habits and practicing them consistently. I do not need to be perfect or eliminate foods I enjoy or buy into a dietary dogma to maintain my success, because I have learned that (mostly) good habits, practiced consistently is more important than ALL those things"

Diana said...

It's an excellent idea for a book, but Jimmy is not the man to write it. I think William Alexander, who wrote the $64 Tomato, and 52 Loaves, would be ideal. He's very smart, and has a common man approach.

Charles Grashow said...

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0040503

Hunter-Gatherer Energetics and Human Obesity

"Data on hunter-gatherer TEE provide additional perspectives on Paleolithic humans and on the origins of farming. While the lifestyle of late Pleistocene hunter-gatherers was no doubt highly active as seen in foragers today, our results suggest that their daily energy requirements were likely no different than current Western populations. And rather than decreasing the work needed to find food, early agriculture may reflect an effort to improve food security and predictability, even at the cost of slightly higher energy demands. The greater energy demands of traditional farming lifestyles evident in this study (Fig. 1, 2) suggest that the adoption of agriculture brought with it an increased workload for Neolithic foragers. This view is consistent with Sahlins’ [47] proposition that Pleistocene hunter-gatherers enjoyed an “original affluence,” spending only a moderate amount of time on subsistence work each day, as well as a recent study indicating that Neolithic foragers were no less productive than early farmers in obtaining food [48]."

Liberrocky said...

@OnePointFive

It is NOT a runaway production of ketone, ketone levels that would put a diabetic in the emergency room (>3.5 mmol/L) are often achieved by LC dieters or those being treated for epilepsy with no ill effects.

In DKA it is the dehydration and electrolyte loss brought on by excess glucose, not the presence of ketones that is the culprit unlike what Evelyn implied.

http://www.ncbi.nlm.nih.gov/pubmed/17241226
http://www.ncbi.nlm.nih.gov/pubmed/17975686







Gabriella Kadar said...

Everybody got paid crap wages. Except the politburo dudes and the KGB.

Gabriella Kadar said...

Based on the annoying newspaper articles generated by the 'team' under the 'Oz' logo, I doubt he even knows what the heck he endorses. I don't watch television so have no idea of how his 'performance' is these days. I'm just waiting for when he gets busted for going bonkers from all the stimulants he's most likely taking. He bruxes and clenches like crazy. Take a look at how all his teeth are ground down to the same length and check out his overdeveloped his masseter muscles. The dude is hyper.

Gabriella Kadar said...

Possibly that's true. I've had to use a glucosemeter for testing animal blood sugars for several years and the results were accurate when compared to lab results. Every so often I'll do a few days on myself because one of my staff appears to be at the cusp of Type 2, and there's no sense just telling someone what to do. It's better to do things as a team. The machine is functioning well.

Diana said...
This comment has been removed by the author.
Evelyn aka CarbSane said...

When I got my meter, it came with a calibration solution and you test a "lot" of strips against that. They are "good" if the measurement was within a wide range, like 40 mg/dL if memory serves, I never bothered wasting a strip on that. I'm pretty sure that my elevated FBG for a week or so was due to using a different lot of strips. These things really ARE intended to be used by diabetics with the notion that error is averaged out over time and adjusting drug/insulin dosages accordingly.

Diana said...

@Gabriella, I've seen Oz's show. The sad part is that he mixes truly good info with the ludicrous, and that he devalues his genuine creds as a cardiac surgeon in his shameless quest for fame. I speak as a former fan of Susan Powter - yes, I admit it. Learning the truth about her (from a person who once worked on production crew and observed her at close range) was an eye-opener. All the facts about her were revealed in the press by Texas Monthly, but I refused to believe it until a friend confirmed them.

That's how this guru-itis spreads: marketing. So now I am a confirmed skeptic/cynic about literally every popularly-ordained guru. Once burned.

Charles Grashow said...

More nutritional ketosis idiocy

http://diagnosisdiet.com/seyfried-ketosis-experiment-day-5/

Charles Grashow said...

http://vimeo.com/52813532

Michael Andreula Interview With Lipidologist Dr. Thomas Dayspring

Charles Grashow said...

http://paleodrama.tumblr.com/

http://cooking.stackexchange.com/questions/19863/are-fungal-toxins-a-significant-problem-in-coffee-and-if-so-can-they-be-avoide

http://www.bulletproofexec.com/why-bad-coffee-makes-you-weak/



The best for last

http://scienceblogs.com/insolence/2008/08/07/a-fungus-among-us-in-oncology/


http://www.curenaturalicancro.com/
TREAT CANCER WITH SODIU, BICARBONATE

http://www.cancerisafungus.com/
CANCER IS A FUNGUS


Isn't the internet fun???

Charles Grashow said...

'World's Fattest Man' Loses 644 Pounds

http://health.yahoo.net/experts/dayinhealth/worlds-fattest-man-loses-630-pounds

http://abcnews.go.com/WN/worlds-fattest-man-life-saving-surgery/story?id=8878882#.UOXxtWfhfYQ

http://www.nytimes.com/2013/02/06/world/europe/paul-mason-is-one-third-the-man-he-used-to-be.html?pagewanted=1&_r=1

IPSWICH, England — Who knows what the worst moment was for Paul Mason — there were so many awful milestones, as he grew fatter and fatter — but a good bet might be when he became too vast to leave his room. To get him to the hospital for a hernia operation, the local fire department had to knock down a wall and extricate him with a forklift.

That was nearly a decade ago, when Mr. Mason weighed about 980 pounds, and the spectacle made him the object of fascinated horror, a freak-show exhibit. The British news media, which like a superlative, appointed him “the world’s fattest man.”

Now the narrative has shifted to one of redemption and second chances. Since a gastric bypass operation in 2010, Mr. Mason, 52 years old and 6 foot 4, has lost nearly two-thirds of his body weight, putting him at about 336 pounds — still obese, but within the realm of plausibility. He is talking about starting a jewelry business.

“My meals are a lot different now than they used to be,” Mr. Mason said during a recent interview in his one-story apartment in a cheerful public housing complex here. For one thing, he no longer eats around the clock. “Food is a necessity, but now I don’t let it control my life anymore,” he said.

Laura Semmens said...

My question with these stories is always: who is bringing them food?

Diana said...

@Laura, you have to read the whole article. State appointed carers brought him massive amounts of food. Is this what the British taxpayer is paying for?

Kurt G. Harris MD said...

There are no trials currently of metformin with ketogenic diet, but there are currently ongoing trials of ketogenic diet as an adjunct to radiotherapy for lung and pancreatic cancer. Preclinical studies suggest adjuncts to autophagy, of which there are many, may simultaneously enhance killing of cancer cells and protect normal cells from damage due to oxidative stress during treatment.

My first thought on the GBM case is all you have to do to stay in remission is lose 20% of your body mass every 2 months. But seriously, we don't know if keto diets work for non- brain tumors and if they do work, do they work via the hypoglycemia as suggested by Seyfried, must there be an energy deficit, or is it the ketosis (cellular signaling and metabolic shifts with elevated BHB, etc) that does the work?

I think cellular signaling of energy availability is key to enhancing tumor cell death and cytostasis, just as it seems to influence cancer incidence. The work on metformin is very suggestive, and it acts in more ways than just inhibiting GNG and lowering sBG. There is currently a large trial in early breast cancer randomizing non-diabetics to metformin or no metformin plus standard therapy. BC incidence, and even more so, survival, are heavily influenced by BMI, insulin resistance*, waist measurements, weight gain after diagnosis, exercise intensity and other indices of energy balance, so I predict that metformin will work in reducing BC relapse as the observational studies already suggest it does*. I also suspect that metabolic effects against cancer can be achieved without sustained negative energy balance.

And anyone claiming to have "beat" breast cancer after only two years is blowing smoke. Women diagnosed with early BC can EASILY live 5 years with minimal or even no treatment. BC is not cancer of the pancreas. This is just more dangerous hucksterism being promoted by Jimmy.

* I don't think metformin will work as well for cancer as regular vigorous exercise and maintaining a very low BMI, though, as it is basically a mimetic of favorable energy balance and exercise is pro-autophagic and pro-apoptotic independently, and low fat mass keeps inflammatory cytokines that promote cancer growth low and keeps adiponectin high - adiponectin lowers cancer risk as well.

Diana said...

@Dr. Harris,

When you cited metformin I thought of berberine.

http://www.ncbi.nlm.nih.gov/pubmed/?term=berberine+%22breast+cancer%22

Interesting, although this is completely above my pay grade.

Gabriella Kadar said...

I was just looking at the diabetic website on glucose testing technique among other things. Why on earth do they show someone drawing a sample from the fleshy part of the first finger when the outer part of the baby finger is the least painful location on the hand? No wonder people don't particularly want to use home glucose monitoring! Ouch!

The meter at work reads 5.9, 5.8.... all day long for me. So either it's accurate or stuck. I know the 14 hour fasting is 5.1 (lab value). There's no glucose curve to speak of. But I'm not eating simple sugars either. Seems 3 small potatoes with yoghurt (yuk) for breakfast doesn't do anything different to the blood glucose than pork belly stew with sauerkraut and mustard greens (yesterday's 4 pm 'lunch')

Back years ago when I was using a glucose meter for the cat and was low carbing, the ambient level was 4.5 to 4.8. But hunger = fatigue. I could forget to eat all day and get around to having supper at 8p.m. But it was tiredness that signaled 'eat something'. The brain gets slow without food for long periods of time.

OT:

One thing that was really interesting: in 2004 I contracted a viral infection which affected the inner ear. So I had nothing to eat for several days. It sensitized the sense of smell. Even just walking through my own home was passing through 'smellscapes'. I could tell by smell when I'd walk by my neighbours doors if they were home or not. I could get off the elevator at work and know who had arrived for work before I did. Or didn't. I mentioned this to my yoga teacher and she confirmed that this is something she has noticed also after prolonged periods of fasting. The situation lasted for about 2 years and then gradually faded back to normal. But it was really interesting to experience life somewhat closer to a dog than a human.

Liberrocky said...

Do you have a link?

Liberrocky said...

@Dr Harris,

What is your opinion of Sloan-Kettering President Craig Thompson's stance:
“If you overfeed someone with fat, you don’t increase their cancer risk at all. If you overfeed someone with carbohydrates, you dramatically increase their cancer risk. Protein is half way in between.”
Source:
https://www.youtube.com/watch?v=WUlE1VHGA40

Kurt G. Harris MD said...

Not familiar with Thompson. My bias would be that overfeeding is macronutrient agnostic. Certainly fat gain and diabetes and don't give you credit for overfeeding based on one or the other macronutrient.

There are observational studies trying to tie cancer incidence to macros, esp fat or "animal fat", but the only ones that show any effect of fat consumption are confounded by caloric excess/ BMI etc. I've never heard anyone make the case that "carbohydrates" cause cancer and of course this idea seems even dumber than animal fat causing cancer. Since obviously the lowest epithelial cancer incidences are found in groups that eat plenty of carbohydrate.

And if I had to guess, I would peg energy excess and deficiency of phytochemicals as important, but biome depletion and consequent immune dysregulation is probably very important to cancer development as it is to autoimmune diseases and allergies. Populations that are riddled with parasites and live in microbiological squalor are remarkably cancer-free. That's not going to be fixed with fat loss, cabbage and green tea, as much as these might help.

Diana said...

To be fair to Dr. Oz, I was looking for info about adrenal fatigue, the disease du jour, and found this sensible article:

http://www.doctoroz.com/videos/adrenal-fatigue-syndrome-real-medical-condition?page=3#copy

Harry's Acolyte said...

Amazing coincidence that Dr. Harris comments here and all of a sudden Richard Nikoley starts damning the doctor with faint praise in his comment section. Out of nowhere, I tell ya.

Evelyn aka CarbSane said...

LOL. I think RN is a secret admirer. grin

Erik said...

I will say, being a first-time carbsane reader here, the comment threads are considerably more stimulating than over at FTA. Drama hasn't stopped me from reading both Nikoley and McEwen every day, I just may have to add Evelyn to turn the Dissonant Duo into the Tangling Trio.

-Erik, who eats both a lot of carbs AND a lot of fat, though usually not in the same sitting.

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