It’s Insulin Resistance, not cholesterol, that causes most degenerative diseases

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If you doubt this watch a few of Dr. Eric Berg’s videos on YouTube. He’s an expert on the ketogenic diet and intermittent fasting. He explains, simply, why it’s Insulin Resistance that creates diabetes, obesity, fatty liver and heart disease, most degenerative diseases.

Having just stumbled across him, it was a coincidence that a friend this morning sent me an email to say his wife was researching foods low in cholesterol to create a healthier diet for them. I wrote this response immediately and figured this is information I should share:

The great majority of our cholesterol is made by the body, not consumed from food. Dietary cholesterol has little impact on us. And, it is a common myth that cholesterol is the culprit of heart disease. Rather than cause obstructions in our arteries, cholesterol shows up like an ambulance, when irritation occurs, to fix it. It’s been shown through scientific studies over decades that just as many people get heart attacks as have low cholesterol as high.

Cholesterol is only threatening when it’s oxidized. Oxidized cholesterol is called Remnant cholesterol. You calculate your remnant cholesterol by adding up your LDL and HDL and subtracting the number from your total cholesterol. If the number is less than 17 that’s optimal. Increasingly higher numbers are less so.

But cholesterol is only a minor player. The real offender is a diet of too much sugar and starch causing too much insulin in the bloodstream. Every time you eat carbs (and there are carbs in almost everything including vegetables, but not in fat), insulin is released to ferry the breakdown of that food or beverage, which is now glucose, from the bloodstream into the cells. Due to our highly refined carb diet, and frequent snacking, extra insulin is being called forth multiple times a day. We begin to develop a state of insulin resistance (IR): either 1) You can’t produce enough insulin for your constant carb consumption and/ or 2) You’re gaining weight (the two go hand in hand) and belly fat blocks the action of insulin. This inefficient use of insulin is what causes obesity, type 2 diabetes, heart disease and brain diseases like dementia and Alzheimer’s – also known as Type 3 diabetes.

Let’s unpack that a little more. Insulin is a fat storage hormone. When it drives sugar (glucose) into the cells from the blood, the glucose gets stored as fat for future energy use.  With the constant consumption of carbs, our bodies run on these for energy and never get to use our stored fat. Insulin being a fat storage hormone, we start gaining weight. As we gain weight, this fat accumulation around our middle further impedes  insulin’s action. Now the body has to push out more insulin to keep blood sugar levels from rising above normal. This typically goes on for years before the body can no longer push out enough insulin and blood sugars noticeably rise. Wham, type 2 diabetes!

The common theory is people get type 2 diabetes because they’re fat. The alternate, and widely growing, theory is people don’t get diabetes because they’re fat. They get fat from years of insulin resistance (IR) due to our heavy carb diet.

Another way to say this: With our highly processed, carb heavy American diet, our body pushes out greater and greater amounts of insulin to drive the sugar into cells where it gets stored (as fat) for later energy use and keep blood sugar in normal range. As the cells reach capacity to hold the fat, insulin drives the sugar into and around vital organs. This happens for years until the maximum amount of insulin the body can produce no longer is enough. Then, after years of insulin resistance you see on your blood test a higher than normal blood sugar level and you’re told you have type 2 diabetes. Most people will also have signs of a fatty liver and the beginning of heart disease.

Most people with type 2 diabetes are started on pills to lower their blood sugar. But the IR has not been resolved. When the pills no longer work  they are put on insulin to keep their blood sugar down. Now they have extremely excessive amounts of insulin circulating in their bloodstream. This drives their blood sugar down, but makes the IR worse, makes the fat accumulation worse, creates more weight gain and fat in and around the organs until the person dies of a heart attack or gets dementia.

So why is IR going unaddressed? Your treating practitioners have been taught diabetes is a condition of high blood sugar, not a condition of insulin resistance. Their focus is to lower the blood sugar, and so the cause, the IR, remains.

It is important to lower high blood sugar, but what’s needed is to work on reducing insulin resistance: address the cause. This can only be done by eating less carbs so less insulin is needed. When insulin levels fall, weight comes off and the body begins to normalize its blood sugar. Sugar, not fat, insulin, not cholesterol, are responsible for 2 out of 3 people having diseases grouped under diabesity – diabetes, high blood pressure, heart disease, dementia and Alzheimer’s, among others.

This brings us back to the ketogenic diet that is gaining so much popularity. Keto is a very low carb (and so will reduce insulin), moderate protein and high healthy fat diet. People lose weight and  many people are able to reverse their diabetes. I do a modified version of keto.

Intermittent fasting (IF), is often linked with keto as a form of switching the body from burning carbs to burning fat. Like its name, IF means you go longer periods of time without eating. You might fast between finishing dinner around 8 PM and eating lunch the next day. You could not eat for 24 hours or do a fast of several days. IF also significantly drops insulin levels and people lose weight and many reverse their type 2 diabetes. Dr. Jason Fung, is a leading expert in the field.

Just as we’ve heard,  genetics load the gun, but it’s the environment, largely diet, that pulls the trigger. If this speaks to you, do your own research. There’s lots of information online regarding all these topics above.

“Diabetic” foods for being stranded on a desert island should you ever be

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First I hate the word “diabetic” proceeding anything, but hey, I use it here to be able to say that. Second, there’s nothing special about food for people with diabetes. I never eat low sugar or low fat anything. I eat healthy real food that has little to no sugar and healthy fat.

When I used to answer that childhood question – “If you were stranded on a desert island and could only have a few things to eat what would they be?” I would have told you Greek plain yogurt and peanut butter. I could never understand why of all the things they put in yogurt today, peanut butter is still glaringly not one of them.

These days, however, I would slightly amend that request. I’d want what I typically eat for breakfast when I’m not intermittent fasting. I’d want Brown Cow plain yogurt with its incredible creamy top (like the cream that floats to the top of fresh milk) and almond butter (inexpensively purchased from Costco) and tahini (pulverized sesame seeds) which I get from the middle eastern store 1.5 miles away from my home. But I think it can be found in most supermarkets.

I do add some nuts but I’ll skip the nuts since I don’t want to tax whoever is being kind enough to give me some food on this desolate desert island I have somehow found myself on.

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These days if I could ask for one more edible it would be chia seed pudding. Of course it’s one food, but does have several ingredients as you can see above: a can of full fat coconut milk, chia seeds, liquid stevia, unsweetened cocoa powder and cinnamon. I mistakenly left the vanilla out of the picture. I mix it all in that yellow pint-sized container and voila in about an hour in the fridge it’s pudding.

My chia recipe – It really doesn’t get much easier. Fill the container with as much coconut milk as it will hold, most, but not all of this 13.5 oz can, add 4 or 5 tbs of chia seeds. I like 4 so the pudding is not so thick, a few drops of stevia depending how sweet you like it, a teaspoon of vanilla and a handful of blueberries. Today they came out of my freezer. The cocoa powder and cinnamon are optional.

Of course you can really play around with what you add after the coconut milk and chia seeds. Add nuts, different fruits, sometimes I cut a dried prune into the mix. Some people replace the coconut milk with almond or soy milk but I feel the coconut milk has particularly healthy benefits as a short chain fatty acid whatever, whatever… The chia seeds are high in omega 3 antioxidants and fiber, you get anti inflammatory benefits from the cocoa powder and cinnamon seems be a wonder drug with many benefits ascribed to it including lowering blood sugar (which I can’t say I’ve ever noticed) and reduced risk of heart disease.

Now, you do deserve a prettier picture of the pudding than I’ve supplied above along with recipe variations —

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Doubly upset with insulin manufacturers for look-alike insulin pens

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On the top Tresiba long-acting basal insulin. On the bottom FIASP ultra-rapid insulin

Please Novo Nordisk, what are you thinking? Both your Tresiba and FIASP insulin pens are nearly identical. I know already I will at least once, if not more, grab the wrong pen and take seven times my mealtime dose accidentally.

For the first time ever, after 46 years with type 1 diabetes, I’m using Novo Nordisk’s insulins for both my basal and bolus: Tresiba and FIASP.

This is the picture I took this morning of my pens just after looking down at the Tresiba pen in my thigh as I had my finger on the plunger having just pressed it, thinking, “Oh, my god, is that my Tresiba in my leg or the FIASP? SH*T!!!” All I saw was a navy blue pen.

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The caps look different because the Tresiba pen (on the bottom) has a Timesulin cap on it.

I switched to Tresiba and I’m experimenting with FIASP after being a long time user of Sanofi’s Lantus and Lilly’s Humalog. I’m very happy with both insulins. Tresiba covers me a full 24 hours plus, while Lantus only stretched to about 19 hours. And FIASP, which I’ve just started to see if it actually is faster than Humalog, appears to be. No complaints about the insulins. In fact, I’d recommend them easily.

But how could those at pharma companies, whose hands these pens flow through upon creation and sale – device designers, engineers, research and development, business development, marketing and strategy professionals – not consider the risk to patients of confusing these two pens? Untold numbers of people with diabetes will use both these products – just as the company would like them to.

How could one not notice that the identical color of the pens, design and shape will cause many customers to mix them up and result in potentially life-threatening consequences?

I’ve already done it, mixed up my short acting and long acting pens once with two pens from two different companies that were not identical.

Novo Nordisk is not alone, although I find the choice of navy blue for both pens egregious. Here are Sanofi’s Lantus (basal insulin) and Apidra (bolus insulin) pens. Also, far too similar. In “real life” the color difference is not as pronounced; they both share a blue/grey hue.

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Luckily, this morning the correct pen was in my leg. But trust me, in the middle of making breakfast and picking up a pen to take one of my six or so shots a day, the day will come when I take seven units of FIASP (my Tresiba dose) when I meant to take one. Am I to blame? Sure. But make it easier for us to avoid potentially life-threatening mistakes. Make insulin pens mistake-proof.

Why can we not have pens that are dramatically different colors, especially from the same company, different shapes, different texture or make a sound when you take off the cap. Users of insulin pens already take it upon themselves to distinguish their pens by putting duct tape or rubber bands around one pen, or keeping their pens in different rooms. It should not be so hard.

I’d like to see the company that embraces the hippocratic oath, “first do not harm” and reflects it in the pens they put in our hands.

You can do more, you can do better to help people with diabetes have one less thing to worry about – taking an insulin overdose – when they take their medication multiple times a day.

 

Grace for the new year

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Reflecting on this past year I realize how truly rich I am. How many experiences and adventures have colored my days. How many friends and colleagues have enriched my journey. And how grateful I am for family who always give me, and the husband, a safe space to land.

I hope 2019, amid the noisy, chaotic world, is a year we all find our inner stillness; that quiet, vast and unflappable place within us. And that you be touched by the grace of those who come along your path just as you have graced other’s paths.

Wishing you peace, happiness and health in the new year.

The language of diabetes and diabetes-speak

Of all that’s happened in diabetes this year, it was also the year of bringing people’s attention to the judgmental language embedded in our diabetes culture. I offer congratulations to the American Diabetes Association and the American Association of Diabetes Educators who jointly created a white paper on the topic. Among the paper’s recommendations is replacing “diabetic” with “people with diabetes.” Replacing  “test” blood sugar with “check” blood sugar. To never, ever label people with diabetes as “non-adherent” or “non-compliant” and, in general, to use language that is factually correct and judgment free.

That said, there is another language in diabetes. It’s the talk that goes on between those of us who tread water every day with this condition.

My friend just emailed me with this photo of her pump. The photo came with this message, “Just when I’m feeling like I’ve eaten too much and not been exercising…my pump responds with this.”

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You’re wondering what this means. She and I have been talking about noticing the number “111” on her pump and my CGM over the past weeks. Why? Because 111 is called an angel number, a symbol of spiritual awakening, pointing you to your purpose in life. We think it kinda fits us and we think noticing how frequently it shows up is a hoot.

So I of course wrote her back in diabetes-speak —

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Shall we just say I had to laugh when this came up for me this morning —

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Salt, Sugar, Fat: the book about creating the irresistable trifecta

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My last post was about the non-nutritious food served on airlines. If you want to learn how, as a nation, we have ended up with an overabundant supply of not food, but food-like substances, as journalist Michael Pollan, calls them, you should read, Salt, Sugar, Fat: How the Food Giants Hooked Us, by New York Times journalist Michael Moss.

The book is an eye-opening account of the food industry from when it began to employ scientists and marketers, and collude with the government and certain health organizations, to create cheaper food with few real ingredients and many chemicals. How and why the government began paying farmers to overgrow corn, wheat and soy, and how they all promote these fake foods as healthy with false nutrition claims.

There are so many devious, just-this-side-of-lying, and outright lying strategies about the nutritional value of these concoctions of chemicals, you will find the book jaw-dropping; unfortunately, in the worst way.

For example, America’s beloved Velveeta cheese, is a processed cheese-like product invented in 1918. Today, as over the years, its formula has changed, it is labeled as a “pasteurized prepared cheese product,” no longer technically cheese. Certainly it bears no resemblance to cheeses either made by artisanal makers here or in Europe, where the process is slow and personal and the prime ingredient, milk, comes from grass-fed cows.

Oscar Mayer Lunchables, which became a runaway lunch best-seller amongst kids, had not a speck of nutrition in it. It was the company’s way to reel in more money. Tang, which captured America’s heart when astronauts took it into space, has more sugar in it than soda. Cheap hamburger meat, that goes through bleaching and worse, that got termed “pink slime” finally got pulled off supermarket shelves when enough people complained. Trust me, I was raised on Carnation Instant Breakfast Drink and Pop Tarts and daily tuna fish sandwiches on Wonder bread. And an all time favorite, Chef Boy Ar Dee canned ravioli!

The history of how quick, cheap, processed foods arose is fascinating and all here. It started with a Kellogg brother, John Harvey, a doctor, nutritionist and health activist who created a sanitarium for people to regain their health in Battle Creek, Michigan. One of this main staples on the menu was whole grain cereal, no added sugar. When his brother, Will Keith Kellogg, in John’s absence on a trip to Europe, added sugar to the cereal and saw how people loved it, he split away from his brother and created the first sugar-laden breakfast cereal – Kellogg’s Frosted Flakes. Frosted with what? Sugar. American breakfast was born.

Coca Cola is given a lot of attention as a genius company for strategizing and turning the entire world onto Coke. During WWII they got Coke out to soldiers on battlefields, adding a patriotic feel to the product, and into gas station vending machines across the country.  Sad to say today as Americans recently began to drink less Coke, understanding the health risks, Coca Cola began exporting Coke overseas to hook poor people in underdeveloped nations.

You cannot read this book and not understand why we’re facing our current healthcare crisis and epidemic of chronic illness. And why what you eat is at the root of health, and disease.

Best and worst airline food

Each time I’m on an airplane I marvel again at how unhealthy the food is. Yes, if I can, I bring my own food on board, but that’s not always possible. I don’t eat the white bread roll and chemical-heavy salad dressing. I don’t eat whatever processed snack item they may serve like fake pizza. If I actually get a meal, I usually eat the protein and veg of the entree, skip the dessert, and save the cheese for a few hours later.

How interesting that someone actually rated the best and worst foods among most airlines. Turns out Alaska Airlines came in first place. Darn, not much chance I’m going to Alaska anytime soon.

Still, it’s interesting to see how our major and smaller airlines stack up – A ‘diet detective’ rates the best and worst US airline foods or health.

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How many chances I have to be wrong every day

Every time I check my blood sugar I have the opportunity to be wrong – about what I thought the number would be, what range I’d be in, too high, too low. These mistakes are consequences of my every-few-hour analysis and decision-making regarding how much insulin to take for the next meal or correction.

Every single day I have multiple opportunities to be wrong about these decisions, which we know, PWD to PWD, are merely guesses.

So when I woke up this morning to a blood sugar of 126 mg/dl, I thought about this and I wondered how does being wrong several times a day, or few days, affect me and my sense of self? Here’s the 126 backstory: last night after a miscalculation of how much insulin I needed for dinner, my blood sugar dropped to 68. I ate a third of a cup of blueberries, after checking with CalorieKing how much frozen blueberries would raise me. But, obviously, I misjudged. (Or my body was doing something I had no clue about). I wanted to get myself up to 100, yet I awoke at 126.

Obviously, I didn’t need as many blueberries as I thought. Ten too many? Five too many? Obviously I should have waited longer after eating them before going to sleep to see how much they raised my blood sugar. I should I have stayed up til 1 AM rather than let my jet lag push me into bed at 10:30 PM. Obviously. Once again I made a mistake.

How does this affect us? Judging ourselves as often making mistakes when we can only guess at insulin dosing? I am fortunate that I know you cannot predict or control blood sugar. I know that even with my CGM insulin dosing is still, and always, an educated guess. I am also fortunate that I can usually move on from my self-criticism quickly and appreciate that I manage my blood sugar as well as I do.

Someone once said to me if you have type 1 diabetes, “You’re either a super-hero or a train wreck.” I have known train wrecks. They are not around anymore. Fortunately, most of the people I know today who have type 1 diabetes are super-heroes.

Yet that’s not really an apt metaphor and my super-hero friends and acquaintances would likely agree. Yes, we have a second job managing our blood sugar and diabetes. Yes, our life-saving medicine, insulin, can kill us if we guess terribly wrong. Yet there’s no way to know for sure each time we dose insulin exactly how much we need. And please don’t even get me started on riding the “roller coaster.”

If you truly understand what type 1 diabetes requires to manage it well, you could see those who do so as super-heroes. Yet I know we’re all just doing our best, day in and day out. We rely on the help and support of others when we need it and we roll with the punches knowing insulin dosing is neither science nor art. It is a calculated guess based on mystery, the mystery of what your body is doing at any given moment that is largely hidden from us.

Still, we continue, decision-guessing multiple times a day, day after day, rarely saying anything about it. I imagine, you like me, hear the voice of your self-critic when the number on your meter isn’t what you want or expect. And then you move on to make the next guess, hopefully, forgiving yourself with equal speed. Perhaps that’s really the definition of a diabetes super-hero.

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Teaching diabetes care in Copenhagen, traveling in the Netherlands

It’s been a few weeks since I posted. I’ve been in Europe both working and relaxing. I was invited to present the Flourishing Approach to practitioners at, and related to, Steno Diabetes Center in Copenhagen. Steno is a leading research institute and clinic in Denmark. The interaction was extremely successful, including a meeting with the CEO of Steno, Allan Flyvbjerg, who is looking for innovative ways to progress diabetes care and sees the value of the Flourishing Approach.

That morning I and the husband presented the Flourishing Approach to health psychology students at the University of Copenhagen. It was enormously rewarding relaying ideas of a different way of seeing and working with people who have a condition to such young, curious and fertile minds. And not one was on their iPhone during our talk! Instead they were surprised, fascinated and curious what diabetes really is and is like to live with. I am grateful to psychologist Timothy Skinner who invited us to take over his class.

It’s both fun and rewarding that Copenhagen is one of the world’s cities where the Flourishing Approach is connecting since I lived there for a semester during my junior year of college. How well I remember sleeping under the hugely warm white, white duvet and bicycling in the dark from house to train station to go into the city for classes. As I told the students, I could never have envisioned I would be back teaching at the university one day.

All to say it’s been rewarding work and a wonderful trip. Now back in the Netherlands, the husband’s home country, there’s a week left to wander down these beautiful cobblestoned streets and admire the centuries old buildings and canals.

A smattering of the trip in photos:

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Painting: The Anatomy Lesson of Dr. Nicolaes Tulp. Painted in 1632 I use this in my presentation to show how focused we are in health care on the body alone. I took this photo in the Mauritshuis museum here in Holland.

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Totally insulin-worthy Appel Cake at a bookstore in Amsterdam

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A popular bridge in the center of Copenhagen. The locks represents couple’s love.

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Lecturing health psychology students at the University of Copenhagen

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Presenting at Steno Diabetes Institute in Copenhagen

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A new T1D friend, Helle. We were LinkedIN until she reached out and showed us her Copenhagen. I am indebted.

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Leaving Copenhagen. They don’t let you forget smoking is not good for your health.

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KLM snack on the flight back to Holland. A teaspoon of egg in a wrap. Putting profit before health. Sad to see.