Wednesday, February 27, 2013

Diabetes: Why you should critically analyze your doctors advice

I wrote the following as a note in facebook. I think it gives a very good idea of why and what a diabetic must do. My understanding has evolved since then, but I only make small modifications to it as it is still not wrong.

A friends father passed away today. It was a case of complications due to Diabetes. It resulted in Heart Attack. His father did love meat, and he could have cured his disease if he could be convinced to not follow his doctors advice.

Diabetes is not an incurable disease, provided you understand why your doctor recommends the diet he does and why it is exactly the wrong kind of diet for Diabetes. Dr. Bernstein is a great example, of what can be done with patience and critical thinking.

Dr. Bernstein is a Type1 diabetes patient. He was diagnosed at 12 years of age. He discovered the cure for diabetes at the age of 35 when he got hold of a glucose meter. At that time he was suffering from ill health due to diabetes. When he discovered the cure, he stopped suffering and has been healthy since. He is now 76 years of age, and very active. He is still running his practice. In fact he is now at the age which is the average expected age for normal people. He wasn't a doctor to begin with, he became a doctor because he wanted to help other diabetes patients, and his cure was not accepted by other people. To be able to convince other people he studied to become a doctor.

Dr. Bernstein is living with this disease for the last 64 Years, of which the first 23 were without understanding and following his doctors advice. These 23 years were miserable. The next 41 years he has lived with his understanding and he is happy. How many people survive for 41 years with diabetes following their doctors advice? How many do it while enjoying life?

It is important to remember that Type1 diabetes is much worse than Type2. Type1 normally occurs due to an auto-immune condition, where the Beta cells in Pancreas have been killed. A Type1 is unable to produce sufficient insulin for signalling consumption of nutrients including glucose. A type1 diabetic is emanciated because he/she cannot store amino-acids to allow muscle growth, cannot store triglycerides to build fat storage, cannot store glycogen to allow heavy physical work. All in all they have a very difficult life. They need exogenous insulin to survive.

Type2 diabetes is a condition where the liver, muscles, fat cells have become resistant to insulin, and do not react to it. Some of it is due to the fact that muscles and liver are choc full of glucose and cannot accomodate anymore of it. Some of it is because the cells insulin receptors have been damaged. They are producing enough or maybe even a lot of insulin. That is not where the problem is. The solution given is metformin which acts like insulin but bypasses the resistance. This will work for some time. The other solution is exogenous insulin, which is like increasing the volume when you are going deaf. It works some time, and then you grow more resistant, just like growing more deaf with extra volume.

Most people are Type 2 Diabetics. Type1 normally happens to children, although the auto-immune attack can happen at any age, it is more likely to happen in children. If you got it at an old age, it is almost always going to be Type2. If Dr. Bernstein is still alive and healthy at a ripe old age of 76, even though he has Type1 diabetes, anybody with Type2 can do the same, more easily. You just need to understand the basics, and have the patience and resilience to avoid stuff that is bad for you.

Diabetes is one of the simpler diseases to understand. It is basically an inability to use glucose. The food we eat if it contains starch will convert to glucose in the body. The body normally reacts by storing the glucose as glycogen and converting the excess to fat and storing it as triglycerides in fat cells. A Type2 Diabetic person cannot store the glucose, because the cells do not see that there is glucose around. The liver does not see that there is glucose around. The result is that glucose stays high in the blood.

It is interesting to note that the ideal blood sugar level is 80mg/dl, and the max acceptable blood sugar level is 140mg/dl. Given that an average person has about 5ltrs of blood, these levels amount to 4gms and 7gms respectively. The difference between ideal and max is just 3gms, which is about a half teaspoon of sugar. So we do not want to eat anything that will provide this much sugar, at a fast rate. The recommendation of low glycemic dieting and eating multiple times a day arrives from this fact. But the real information is lost, that 3gms is the limit.

A healthy persons body will be able to get rid of 200gms of sugar in one hour, stored as glycogen. But this does not apply to a diabetic person. Typically, they are not even able to store 10gms in an hour. Given that even low glycemic foods do not have a peak that lasts for more than an hour, it is highly recommended to check with a glucose meter, when the peak occurs for each food, and take care to consume only the amount of carbs that will not cause a peak higher than 140mg/dl. This is time consuming, painful, but the only effective method of controlling diabetes.

An easy solution obviously is to not eat anything that will convert to glucose. This may sound easy to do but it has pitfalls here. If you do not eat carbs, the blood sugar level can drop to dangerous levels, because the liver does not see that there is too little glucose in the blood. It is the task of liver to supply glucose when it is running low. This makes it quite dangerous to not eat glucose.

The minimum daily requirement of glucose is about 50gms, provided atleast 100gms of protein is eaten everyday. A diet which provides these would be able to keep diabetes in check, without any bad effects. The carbs should be split into 4-6 meals and snacks, separated at equal intervals. At 5 meals it would be 10gms per meal. Another interesting thing to note is that the stomach delays emptying with protein or fat is present in the meal or snack. It does not do so unfortunately for carbs, as it cannot do any digestion for them. Protein and Fat need to be carefully split into smaller components before releasing which reduces the rate at which stomach empties.

A mixed snack/meal with a small amount of carbs with fat and proteins, eaten at regular intervals would be very helpful in keeping the blood sugar level constant the whole day. It would avoid precipituous falls and high peaks.

In the initial period the glycogen stores are full. This means that requirement of glucose will be much lower. This is the reason that Atkins diet called for a Initiation Phase where 20gms of Nett carbs (basically fiber) was only allowed. During this phase liver and muscle glycogen gets utilized. A side effect of this for diabetics is to increase insulin sensitivity. Also a side effect of a high fat low carb and moderate protein diet is that you lose appetite. This would mean that you will lose weight.

Another pitfall in switching to this diet is that any insulin or metformin must be stopped or reduced, as they would cause the blood sugar level to drop too much. This does require the experience of a doctor, who has worked with this kind of diet. Or the patient must take a lot of risks, just like Dr. Bernstein did. His books will help understand the problem, and provide a method to fix it. So read it carefully, if you can't find a helpful doctor.

The above still does not explain why fat will not be harmful even though everybody claims that the fats are the devils.

Firstly, carbs are the overriding problem here. Nobody says that you will die immediately if you eat a lot of fat. But a diabetic will die if he/she eats a lot of carbs.

Second if you have read the above carefully, you would have noticed that carbs can convert to fat, and it converts to saturated fat, a particular fat called Palmitic Acid. Everybody who calls fat bad, they call saturated fat super bad. And carbs do convert into saturated fats. So by that logic carbs are super bad. But rest assured our body is not trying to kill us by creating saturated fats. It creates saturated fats because it is very stable, and it has a high energy density, so that it can store lots of energy safely. So carbs are not a problem because the body neutralizes it as saturated fat. This does mean that Saturated fat is not a bad thing to eat. It is logical, but most people (including doctors) are not very strong in logic.

Glucose to fat conversion happens only in people that are gaining weight. This happens for people who are losing their insulin sensitivity. Normally Liver and muscle cells lose sensitivity first and fat cells last. So these people tend to gain weight, till the point that fat cells lose sensitivity. At which point they move into diabetic phase.

Thirdly protein can convert to glucose, but do so only when glucose is required, so exceeding the limits of proteins will not have a detrimental effect on glucose control. In fact there are some proteins that do not convert to glucose. Eating more of these would be helpful. These are lysine and leucine, and are found in BCAA mixes that body builders use to enhance performance. Still making protein a very large part of the diet will be problematic.

There are some other considerations but those are minor. Supplementing Magnesium and Chromium helps improve insulin sensitivity. Omega3 supplements (such as fish oil) are also very helpful. As also is avoiding any concentrated source of omega6. If an oil contains more than 10% Omega6 avoid it, or keep the consumption below a tea spoon per day of all such oils. The best oils are ghee, butter, coconut oil, olive oil, palm kernel oil, High Oleic Sunflower oil, and animal fats. There are some others which are much more expensive.

The bottom line is that Diabetes requires some sacrifice. If you equate Food with Living then unfortunately, there is no solution for you. You are bound to suffer, and you can only hope for a quick death in the form of a heart attack, rather than lose the kidneys and the be on dialysis for a long time. If you have diabetes, hopefully this article has provided you with some pointers, and a drive to analyze your situation critically.

Wednesday, February 6, 2013

Do heart patients have high cholesterol?

We always hear from our doctors how high cholesterol will cause you to get heart disease. This would imply that people getting into hospitals due to heart disease, would have a high cholesterol. I would have thought that this would be the first thing to test. But the medical world works in mysterious ways.

There has been a 2008 paper where the cholesterol values of the people entering hospitals due to heart disease was collected. These people collected data from 1,36,905 hospitalizations. Luckily the paper is freely available online. Following is the most interesting image from the paper.

We can see by extrapolating from the bars, that about 50% of the people have the following ranges of Cholesterol values. Unfortunately they did not do men and women separately, as another paper has shown that cholesterol response varies a lot between men and women. I have written an article on the paper.

LDL - 75-125
HDL - 30-45
Triglycerides - 80-160

They did not measure VLDL, which is normally tracks Triglycerides.

Now one can see that the cholesterol is perfectly within guidelines given by the Doctors. The HDL is a bit lower. The paper also noted this fact but then recommended that the guidelines need to be lowered. This makes no sense, because they have not yet established that people without heart disease have lower cholesterol.

Following is an attempt to find cholesterol data for all american people, not just stricken with heart disease.

I searched for American research papers or data giving a similar graph for normal people. Unfortunately, I cannot find anything recent. The closest we have is the data from 1976-80. I also found data from 1971-74, and 1960-62. The govt has stopped collecting the data in this format. I wonder why :-). The same problem is with the BHF heart stats from UK. Unfortunately the only data which we can use is the first one, as the other two do not give the data for all adults, they segregate it into males and females. Also we want the most recent data, so we will look at the 1976-80 data.

So lets see how the data looks like. Again the range of cholesterol for 50% of the population.
TC - 179-239
HDL - 37-51
Non-HDL - 131-195
Triglycerides - 84-168

There are not too many points of comparison. Triglycerides are very similar. HDL levels are quite a bit lower in the people with heart disease. Non-HDL includes LDL and VLDL. VLDL is normally a very small number, and is directly dependent on the Triglycerides. Even if we remove a small amount for the VLDL, we still have a very low values for LDL cholesterol in the people with heart disease. Now it is also possible, that LDL has reduced for all the people, due to the dietary measures applied by the normal public. Unfortunately we cannot compare newer numbers, as the govts do not measure the current distribution of cholesterol. The numbers they collect are pretty useless for making any inferences.

If the LDL numbers have really dropped so drastically, we should see a large drop in heart disease incidence, because of the reduced LDL. Unfortunately, that is not the case.

We can see that the incidence of heart disease has remained nearly same, since 1980, from when we see the data. The mortality has reduced but that is probably due to better patient care and new surgical methods and technologies. Some of the rise in the incidence can also be attributed to better diagnosis.

Unfortunately, lack of recent data makes it difficult to have a proper conclusion. But the available data is not positive for the current cholesterol hypothesis.

Understanding Stress

I believe that Stress is the most important factor in our health. It is very important to understand what it is and that will hopefully help you control it. Controlling it obviously requires help from your family, will power, and circumstances.

There are two types of stress, short term and long term. Short term stress causes the body to take several measures to deal with it. In general these measures improve the body. It is called Hormesis. The stress if it continues too long wears down the defenses of the body, and causes long term damage. There is a saying "If something doesn't kill you, it makes you stronger". The implied thing in the saying is that whatever that something was did stop at some point. This saying is about short term stress.

It is very important to subject your body to short term stress. But for each short term stress there must be a period that does not have that stress. The stronger the short term stress the shorter it should be. The stronger the short term stress the stronger the benefits will be. The stronger the short term stress the longer the recovery will need to be.

Stresses can be divided into two groups, physiological and psychological. The body is managed by the brain. Psychological stresses cause indirect stress to the body, and cause physiological stresses. The same thing happens in the other way as well. The body cannot be split into two parts in that way, so it is not worth splitting the stresses this way.

Stresses can also be broadly classified into the following types.
1) Physical - Cuts, bruises, fatigue, exercise, etc.
2) Food - fasting, overeating, toxins in food and due to pesticides, lack of nutrients, etc.
3) Environmental - pollution, infections, chemical use at home and in kitchen, etc.
4) Circadian Rhythm - Lack of sleep, doing things at wrong time, no sun, etc.
5) Mental - Deadlines, inter personal, lack of vacations, over work, worry, etc.

Stresses cause harm to the body if they continue for long. It is important to take vacations to de-stress. Take time off to do something that you enjoy. Some people are able to switch off and do something else. These people will be able to de-stress more easily than other people.

Physical form of stresses can de-stress psychological ones. ie Exercising can take mind off deadlines and other work or family related stresses.

Basically you want to keep your stresses short term. You may have to take drastic actions, if you are not able to do that, for your long term health.

Some things that you can do without changing your lifestyle much, while still having a large impact on your life.
1) Do some exercise: You don't need to do lot of exercise. Something is better than nothing. Remember, if you keep it very intense a short one will require a long break :-). So keep your exercise short and intense. Pushups and situps are good enough, and you can do them anywhere. The trick is to make it intense.
2) Switch oils: Remove refined oils, and bring in ghee/coconut oil/unrefined mustard and other traditional oils. Prefer to use ghee/coconut oil when ever possible.
3) Reduce quantity of grains/legumes: Prefer larger portions of vegetables and meat over grains and legumes.
4) Make a habit of eating curd/pickles: Reduce spices in your vegetables and replace with pickles, hopefully home made :-). This will also allow you to eat more vegetables. Use vinegar, lemon juice and other sour fruits for the sour flavor. It helps improve digestion, and better sleep.
5) Take vacations: This is very important. Relax or do something relaxing over weekends. If the job does not allow that, check if you are stressed due to the job.
6) Reduce chemical use at home: Try to use less chemicals, particularly those that you are using to kill bacteria/germs. Bacteria are good for you.
7) Sleep: Try to sleep early, and get a good night sleep. 7-8 hours is best. Eat lesser in the evening or eat it early enough, so that the stomach is restful during sleep.
8) Fast: Fast intermittently. Its easier to do it by delaying breakfast and skipping meals. Remember doing it from the dinner adds your sleeping time to the fast.
9) Get some sun, or get a Vit D gelcap.
10) Try to find organic vegetables and meats. Preferable is to get underground and leafy vegetables as organic. Avoid chicken (unless free range aka desi), prefer mutton.

Friday, February 1, 2013

A Success Story

I had come across a Facebook entry from Vijayalaxmi, about her headaches while exercising. I thought it had to be due to a low fat diet. This turned out to be true. Then we started chatting about her health, and what could be done about it. She turned around her diet completely, and now feels much better. Below is Vijayalaxmi about her journey.


I am a 41 year old female and my weight loss journey started in 2003, when I had decided it was high time I shed the post-partum weight. Initially, I started a ‘no white’ diet, which became a lifestyle change for a decade (until a few months back)- I would not eat sugar, processed flour and rice. I ate a lot of vegetables, sprouts and chapattis. I was a vegetarian. I used to workout (yes consistency was my plus point). Things were all fine, until I hit the plateau. So, I started reducing my portions. I stopped having ghee, butter, cheese or any goodies. I lived on fruits day in and day out. It satisfied my sugar urge. I was happy to that extent. If I felt very hungry, I would have tea and biscuits/brown bread, because I thought I got my nutrition from fruits. I would eat rice/chapatti once a week, otherwise no junk food.

The problem I had was, I was beginning to gain weight after a decade- with all the low calorie/natural fruit diet and exercise. Also, I was slowing down on my workouts, until I stopped them, because I used to get pounding headaches. I had migraines (supposedly) for the past 8-9 years. They would recur once a week and as a working woman, who had to manage family and also earn more academic degrees, it was really really tough. Over a period of time I would get headaches even if I walked for 10 mins. My eyesight would blur, I developed dry skin psoriasis and I felt tired and drained all the time.

This was towards the mid of 2012. I was desperately searching for help. My family of doctors and other ‘specialist’ docs passed it on as ‘came with age, will go with age’. Just eat a painkiller to relieve headache (that would mean approximately 15 tabs a month).

It was during this time that I stumbled upon Anand Srivastava, who offered help, which changed my perception towards food and life. He sent me a ppt of his weight loss journey. I could relate to his internal inflammations and I was secretly glad, that I was not the only one undergoing this gradual deterioration. I religiously followed his advice and suggestions, which included becoming an omnivore (it was my personal choice to take his suggestions seriously). Based on his advice, I started eating eggs, poultry and fish. I added a lot of ghee to my food. Anand was encouraging me to add more ghee to my food! I stopped vegetable oils and used a range of oils to cook (peanut oil, mustard oil, gingelly oil, olive oil and coconut oil and of course lots and lots of ghee). I added a lot of vegetables (cooked and uncooked ), coconut and also potatoes and sweet potatoes to my diet- it was like karma, I owed my body all that I had deprived it from. Slowly I started intermittent fasting- 14 hours, 16 hours, 20 hours and now 24 hours.

Within a month, I lost 5 kgs, without any workouts and by eating well. I was 69 kgs then, and now I wobble around 64-65 kgs. Weight loss was not my agenda, when I spoke to Anand. It was actually reducing the symptoms of all internal inflammations, which I think I achieved. Today, I eat healthy and clean, I lift weights 5-6 times a week and I have so much more energy. No more blurring of vision or headaches while doing workouts. My phobia for food is gone. Of course, I don’t eat samosas, bhajjias, murukku or any deep fried stuff (thankfully, I don’t like them). I do eat some sweetmeat every other day.  I am able to bear hunger. Food is not an emergency. I do a 24 hour fast at least once a week- and that’s an incredible achievement for me (previously, I had to eat every 2-3 hours; else I would get a headache). This fasting has reduced my psoriasis incredibly. I don’t know the connection or link, but this is a reality, which I am observing very carefully.

Basically, I have learnt to listen to my body and respect it. I don’t deny myself anything anymore. I am glad; my body is responsible enough to ask only real food. One day, I felt a strong urge to eat bananas (I was a bit depressed) - I just went on a banana eating spree 3-4 at one shot. May be my body needs some nutrient that’s found in banana and I am not able to pick the signal!

The one advice, which I have still not followed, is that of oral supplements. I think it’s a question of time. I am gorging on all that can be eaten, so that my body can absorb all that was denied to it. I am forever indebted to Anand for having shown me the way to a healthy life and helping me regain my energy. I have come to believe that traditional ways of eating are the best, because, most of all that he says is practiced by elders at home (except for the non-veg part). So what started as a weight loss journey has actually become a journey of wellness.