Kurt Harris MD

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« The argument against cereal grains II | Main | Body by Science and PaNu »
Saturday
Mar062010

Diabetes I vs II and diet

I posted a shorter version of this explanation of the difference between Type I and II diabetes on Paleohacks and thought it might be of more general interest.

Technically, diabetes mellitus is just hyperglycemia (High blood glucose) that spills into the urine if it gets high enough - that was how it was originally diagnosed.

Type I and II are actually completely different diseases that just both have the common end result of hyperglycemia - high serum blood glucose or high "blood sugar".

I consider both types of DM to be diseases of civilization related to the neolithic agents.

Type II diabetes is a late consequence of the metabolic syndrome where the primary defect is in the liver - likely due to the neolithic agents fructose and n-6 PUFA injuring the liver and causing both liver and systemic inflammation.

Impaired insulin sensitivity in the liver means the pancreas must secrete more insulin to communicate with the liver (control blood sugar, etc) - peripheral insulin resistance follows, likely as a defensive response to hyperinsulinemia and hyperglycemia (hyperglycemia that the pancreas has trouble controlling despite increased insulin secretion). So initially, in Type II there is more hyperinsulinemia than hyperglycemia. This the reason why by the time Type II is diagnosed, so much damage is already done. Not only is the threshhold for fasting BG too high, the post meal spikes are not tested for routinely and the high insulin levels are flying completely beneath the radar.

Ultimately, the hyperinsulinemia cannot keep up with the hyperglycemia, and when serum BG gets high enough, you get diabetes. The beta cells that make insulin fail, and in fact one of the things that damages them is hyperglycemia itself which is toxic to the beta cell. So you get B cell damage/death in type II eventually as well.

Type I diabetes and LADA (Late onset autoimmune diabetes) or type 1.5 have autoimmune destructon of the islet islet B cells that make insulin. Insulin sensitivity is usually normal.

Relevant to the theme of this blog, you should know that Type I DM is an order of magnitude more common in those with celiac disease and is more common in those with other autoimmune disorders like Hashimoto's thyroiditis, etc. Type I DM is an autoimmune disease that usually has onset in childhood. I believe it relates to leaky gut - with foreign proteins or peptides inducing an immune response via molecular mimicry in the context of an immune system that is likely impaired by excess n-6 linoleic acid and consequent 6:3 imbalance.

In type I DM, the initial damage is caused by the hyperglyemia - excess glycation leads to kidney, nerve and eye damage and inflammation, etc. Later, the damage is also caused by the excess injected insulin required when the patient is put on the ADA diet and the spikes in glucose that inevitably occur due to the inherent lack of precision of injected insulin. As an alternative to the insanity of the ADA, this can be minimized with VLC - a fatty acid/ketone -based metabolim that requires just enough insulin just to tell the liver to hang on the glycogen stores and facilitiate peripheral uptake, not the massive doses of insulin required to compensate for 6 times a day tsunamis of glucose arriving from the gut to keep the glucose from putting you in a coma.

In type II, the initial damage can be thought of as prior to both the hyperglycemia and the the hyperinsulinemia. The initial damage is the suite of early metabolic defects like liver inflammation, steatosis (fatty liver), elevated inflammatory cytokines like IL-6 and TNF-a and likely systemic inflammatory and immune effects that contribute to cancer and immune disorders and atherosclerosis - (you can have these effects as well even if you never develop diabetes and are thin and apparently healthy on the SAD).

Then, when the pancreas is pumping insulin like mad to control BG in the face of liver and increasingly, peripheral, insulin resistance, we are now adding the bad effects of hyperinsulinemia like promotion of more atherosclerosis, degenerative diseases like osteoarthritis, tumor promotion, etc.,etc. Once the pancreas fails, we add the effects of hyperglycemia - the same ones that a Type I can get, like neuropathy, cataracts, damage to the kidneys, and yet more additive effects on inflammation, glycation with increased tissue stiffness, more atherosclerosis and thrombogenesis, etc.

Finally, if you are treated with the ADA diet as a type II, your sBG may be brought under control, but often only at the expense of treating you with EVEN MORE OF THE SAME INSULIN that is causing about half the damage in the first place.

This is the best explanation for the failure of trials of tight glycemic control to show mortality benefits. They do it with drugs that are hepato- or cardio- toxic or with supra-physiologic doses of INSULIN and not by simply having you eat less of the glucose in the first place. The point being, it does you little good to decrease the damage from glucose if you balance with more damage caused by exogenous insulin.

In my opinion, Type II diabetes can actually be cured if it is caught and treated before there is too much beta cell destruction or burn-out. If one fixes the diet and allows enough time for the primary defect in liver sensitivity (and liver inflammation, NAFLD, etc) to heal, this metabolic defect should be reversible. Even if some damage has been done, one can usually avoid medication and especially insulin by lowering carbs to whatever it takes to allow your pancreas to just be occupied with "talking to your liver"

I am aware of at least one young woman who had type I DM diagnosed, and eating a paleo diet, the autoimmune reaction was arrested and she now no longer has diabetes. Usually type I is not diagnosed early enough for this to happen, but it could (and in the one case I am aware of did) reverse if caught right away and treated with a paleo diet

So - Type I low insulin - high sBG - normal insulin sensitivity - can't be cured usually. VLC paleo is the treatment of choice as it allows more stable BG with less exogenous insulin.

Type II - late effect of metabolic syndrome - damage if treated via ADA principles is as much due to hyperinsulinemia as hyperglycemia. Can often be essentially cured with diet. If caught early enough, you are cured if your liver heals and the pancreas recovers or is not that damaged. If caught later and the metabolism remains broken or pancreas is irreversibly burnt out, then VLC PaNu (Bernstein level of carbs or lower) is the treatment of choice

Hat Tip to Peter for the "talking to your liver" metaphor.

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Reader Comments (50)

@Kurt

Out of curiosity (and shooting from the hip), do you think that gout and Type II diabetes might be linked, other than both probably being DoC, related to/a function of metabolic syndrome?

KGH: Both caused by fructose.

March 6, 2010 | Unregistered CommenterPatrik

I appreciate this article.

While I've read more on diabetes than the average lay-person, there were numerous gaps in my knowledge which you plugged.

It was especially interesting to learn about the liver's role in Type II diabetes. I had been thinking about it merely as a disease of the pancreas (and related perhaps in some inflammatory way to pancreatic cancer now shown to happen much more frequently among those taking in more high fructose corn syrup).

I was also intrigued by the idea that autoimmune Type 1 diabetes may be caused at least in part by a leaky gut and reaction to proteins being where they're not meant to be. The SAD and indeed pre-SAD Neolithic diet offers numerous insults to the gut lining, I am realizing.

I don't wish to develop Type II diabetes and I have several risk (and recent behaviour) factors for it. It is reassuring to see how many people have cured their Type II DM with a PaNu-type semi-primal diet when it's caught early enough.

So it should be possible in my case to refrain from developing this disease and undo damage to my liver/pancreas as the case may be. Not that I'm aware of such damage, but as Doug McGuff, MD, was saying, eat healthfully regardless of whether the number is good, bad, or unknown.

Finally, Doctor Harris, you mentioned inflammation as it relates to DM several times.

I realize excess BG, insulin, and dietary fructose and/or excess n-6 linolenic acid are the major risk factors for inflammation which are under our direct control. What do you think about "anti-inflammation" supplements (over and above cod liver/fish oil and Vitamin D)?

For example, you may be familiar with the work of Art Ayers, PhD (molecular, cellular, and developmental biochemistry). Aside from advocating a Paleolithic type diet with low cabohydrate and low n-6 to n-3 ratio using fish oil supplements if need be, he also recommends supplements like Vitamin D (which you advocate) and:

1. Probiotics
2. Glucosamine (but not as a structural component: He believes it benefits the integrity of the gut lining by reducing inflammation, if I'm not grossly simplifying his hypothesis)
3. Vitamin C
http://coolinginflammation.blogspot.com/search/label/anti-inflammatory%20diet

Do you believe these additional supplement recommendations are sensible or likely to be a waste of money and faddish?

KGH:

I've read some of Art's site but only supplement with D, CLO, K2, Mg and selenium. I have no real opinion on glucosamine and I don't supplement with C.

March 6, 2010 | Unregistered CommenterChristoph Dollis

Dr Bernstein recommends A1c of 4.3, keeping BG at 84 with postprandial rises less then 10, and taking Metformin and physiological doses of insulin if needed to obtain these results and allow beta cell regeneration.

I am a Type 2. After 2 years of eating Paleo/PaNu with less then 15gr carbs/day, I was able to obtain A1c of 5 but continued to have high fasting BG, postprandial rises above 50, and neuropathy. Two months ago I started on 3u Levimer AM and PM, 0-4u Novolog ac, and 850 Metformin BID with phenomenal results. My fasting BG is now 70-85 and postprandial rises are less then 10, so I will try stopping the AM Levimer and hope to titrate down to zero meds if possible.

I noticed you advised another reader, "With A1c 5% I would throw away my BG meter - stop measuring and worrying, just eat."

Now I am torn. It takes a great deal of effort to maintain such tight control and avoid hypos and weight gain, yet Dr B feels the results are worth it. I know how much better I feel without the lethargy caused from higher readings, and I have sensation returning to my feet and legs. I would rather not take the exogenous insulin and hate taking the Metformin, but I am thinking my beta cells and liver are already showing signs of healing within the brief time on this regimen, and that did not seem to be happening with diet and exercise alone.

I'd appreciate any feedback.

KGH: I can't give specific medical advice but it sounds like you are doing well. The "throw away the BG meter" remark was not made to a diabetic, obviously.

For reasons not entirely clear to me, diabetics under tight control are often able to get A1c levels much lower than normal healthy people who have never had a hint of diabetes. May reflect red cell survival or something.

March 6, 2010 | Unregistered CommenterRene

Kurt, thanks for the straight forward overview of DM. Straight forward, but far from dull! The treatment seems painfully obvious and simple.

Not that I wish it upon any of them, but if some celebrity chef were to develop diabetes, it would be wonderful to see them figure out the dietary angle and bring attention to a PaNu-like way of eating. Could save a lot of people from needless decline and early death.

Ian

KGH: Most of the chefs on TV (other than Bourdain the carnivore) pretty obviously have metabolic syndrome just by looking at them.

March 6, 2010 | Unregistered CommenterIan Lucas

Dr. Harris,
Nice, easily readable yet technical enough explanation of the difference between DM I & II. I appreciate having this resource to send patients and other curious people to. I think, as you highlighted, it's important to educate people that the damage of diabetes (DM II) is occurring long before the diagnosis of DM. When a person is diagnosed with metabolic syndrome, we should absolutely not take a watch and wait approach, or minimal intervention approach, that is the time to aggressively intervene.

Also just wanted to say that in my community (Naturopathic doctors) we've also seen a handful of DM I's "reverse" the disease if caught early enough as well, so it is possible, though not common.

Keep up the good work.

Regards,
Dr. Tim Gerstmar

March 6, 2010 | Unregistered CommenterDr. Tim Gerstmar

Excellent summary! I've read bits of pieces of this explanation elsewhere, but it was nice to have it summarized in one place so that my brain can get a handle on it.

Everything you said makes perfect sense, but when I try to talk to seemingly intelligent diabetics about this they don't want any part of it. They seem to think they are fated for life to take insulin, develop cataracts, and have poor peripheral circulation leading to possible amputations late in life. On top of that most of them have no idea of the connection between excess insulin and heart disease.

My T2 diabetic FIL eats corn flakes for breakfast, sandwiches for lunch, and has potatoes or some other starchy food with dinner. On top of that he often eats sugar laden desserts, like ice cream. He thinks nothing of shooting up with insulin. Of course the doctor has him on statins and blood pressure meds. He doesn't even have high blood pressure, but the docs wants him to take meds as a preventative measure!!! Such stupidity. What ever happened to the Hippocratic oath?

KGH: It's mind-blowing isn't it?

March 6, 2010 | Unregistered CommenterCavePainter

After reading Dr. Davis I picked up a BG monitor and started tracking BG 1 hour after eating etc.

My fasted A.M. reading was 86.4 and typically 1 hour after eating it was in the mid 80's with the highest being 93.6. It's all good as below the 100 Dr. Davis recommends but harking back to your self-testing sidebar I was saddened it wasn't lower as I'm ZC and in ketosis.

My wife who is a high carb, sugar, chocolate, sweets, coffee, processed food, etc. consumer had a fasting BG of 70.2 and better readings than I 1 hour after meals.

My opportunity for preaching was not available! :-)

I'm very lean and carry a good bit of muscle so was wondering if this would actually be a barrier to a lower reading?

Does my wife's higher BMI / bodyfat actually "soak up" some of her BG, whereas mine has "nowhere to go"?

The science is beyond me but thought I'd ask out of interest. Keep up the great work.

KGH:

Read Peter's posts on "physiologic insulin sensitivity".

Some of the difference between you and your wife is due to muscle insulin sensitivity - hers is higher because she runs on carbs. VLC or especially ZC people always have higher fasting BG and will often fail OGTT with a crab load that carb eaters can handle. Why are you ZC anyway?

What are you and the wife's respective A1c and fasting insulin and fasting TG levels?

March 6, 2010 | Unregistered CommenterWinalot

So, by Berstein level of carbohydrates you mean 6 carbs breakfast, 12 carbs lunch, 12 carbs dinner. Also, if you need to lose weight---6 oz of protein per meal and if you don't lose weight eliminating another 2oz of protein from one of your meals for the week until you do lose weight?

March 6, 2010 | Unregistered CommenterAllison

I believe I am in the type two boat described above, but hopefully have caught it early enough. I bought a BG monitor (actually to check my son, who doesn't have health insurance and has sky high triglycerides) and while learning how to use it found I regularly have fasting BG of 110-115, and after a breakfast of hot cereal with cream and boiled eggs I shot up to 160. Not horrible numbers, but clearly trending in the wrong direction.

I have gotten my post meal numbers down by following paleo type eating patterns (I have celiac so I was off gluten any way) and adding a 2 mile walk most days, but I am really struggling to get the fasting number down to normal. Would you have any tips? I had eliminated omega 6 oils over a year ago, do take fish oil, etc.

Since I started typing someone else posted about the issue as well, I would add that I have gotten my D up from non-measurable to around 45, take K2, B complex, extra B2 and B12, magnesium, and a few other supplements, as well as alternate between taking turmeric, oregano, ginger, and other anti-inflammatory herbs, and use pro-biotics.

KGH: you day "down" -how much? what is your fasting and pp BG now?

March 6, 2010 | Unregistered CommenterRachael

I need something cleared up here...
Peripheral insulin resistance from eating VLC = OK
Peripheral insulin resistance from eating tons of carbs over the year = bad.

Both result in a high fasting glucose. It would seem that's bad no matter what the cause is.

In winalot's example, it's stated that his wife's 1 hour post pradinal of 70.2 is because she eats lost of carbs, but isn't' that what can cause insulin resistance in the first place?.

Someone set me straight on why insulin resistance is OK in one scenario, and not in another.

Thanks.

KGH:

No, he said her fasting BG was 70 and pp BG was "better than his"

Muscle insulin rssistance in response to low carb is OK and in fact necessary to keep you from being hypoglycemic - you need the glucose to diffuse into your brain.

Liver insulin resistance (and later muscle) in the face of high insulin and sBG is bad.

March 6, 2010 | Unregistered CommenterDave, RN

Kurt,

The get started section is designed to reverse metabolic syndrome correct? If I have metabolic syndrome/diabetes just follow that?

It seems I've caught my type 2 quite quickly as my fasting BG in the morning is 75 and my HbA1c is under 5 hopefully I have a good deal of my pancreas left.

March 6, 2010 | Unregistered CommenterBrian

>>> Why are you ZC anyway?

TBH I feel better ZC and being an all or nothing personality type the only carbs I tend to eat are lettuce and broccoli.

Have reduced my depression and increased my lean mass the more fat I consume. I'm a high energy consumer typically 5000+ calories or I drop weight, muscle. Peter has commented I should perhaps get out of ketosis with some carbs, but I do get stuck in one approach typically.

>>> What are you and the wife's respective A1c and fasting insulin and fasting TG levels?

Never had them tested (and not sure what they mean_. As mentioned the BG monitor was a whim after I saw a cheap one of the type Dr. D. recommended on eBay.

What does A1c demonstrate? And how does LP factor into things, I see this mentioned a bit, especially with my long, lean, build?

Looking forward to your post on bloodwork to obtain, even though I'll be disappointed should the results not fall in a "magical" recommended range!

March 6, 2010 | Unregistered CommenterWinalot

Do you have any thoughts on the risk factors (including epigenetic, like over-developed pancreases) for offspring of mothers diagnosed with gestational diabetes? I was diagnosed with GDM in 1998 during my only pregnancy (I was 36 yoa). At that time there was no known family history of diabetes of any sort.

Once I got the hang of counting carbs instead of following the ADA diet, a low sugar/low starch 60 gm CHO/day during my third trimester resulted in excellent BG control, a fast and relatively easy-though-induced birth (because I hadn't gone into labor by due date), only 14 pre-pregnancy pounds to lose after the birth which melted away with breastfeeding, and most importantly, a healthy, normal weight baby. FWIW, I now think I was hyperglycemic long before the pregnancy; the increased screening during pregnancy simply detected it.

With doctor's OK, I went back to my high carb diet after the birth and once weaning was complete, started to gain 5 pounds a year (via a bread machine, lots of pasta and grain foods again). In 2004 I adopted LC and lost weight easily. I was still curious about the surprising GDM dx and continued to seek out information. Eventually I stumbled on Jenny's Blood Sugar 101 website, quickly realizing when I began experimenting with a BG meter I still could get diabetic ppBG readings that wouldn't be reflected on my annual exam FBG and Trig lab results (so not caught by my doctors). My FBG tends to be high-normal and hovers around 100 on average (though ave 110 on my old HC diet. I can keep my ppG fairly normal (under 120 if I am careful) but Cheerios, a slice of Costco pizza, or a frozen mocha drink (just as tests, of course) will quickly send my BG to the mid200s. I suspect my 1st phase insulin response is shot. So called low-glycemic whole grains still elevate my ppBG too high and for too long, so I avoid starchy foods overall. The endos I have seen for hypothyroidism since 2006 are not really interested in my BG issue or what caused it because to them I have it under control. Last year I went strictly GF after my son and I tested + to anti-gliadin IgA antibodies (& more) as well as 2 HLA genes each via Enterolab's complete test panel (no more inflammation in a couple of arthritic joints - yay!).

My younger sister just missed the cutoff for a GDM dx during her two OGTTs during her two earlier pregnancies (& cutoffs were higher then) and her babies were both in the 8-9 lb range and she gained a lot of excess weight. Turns out the same year I was pregnant and surprised to be diagnosed with GDM, a maternal uncle and his son (also in mid 30s) were diagnosed with T2DM. Within the past few years my mother was also diagnosed with T2DM after 25 years of a night shift nursing career (in addition to being chronically sleep and Vit D deficient, also very AHA compliant for 2+ decades with LF/HC diet, HRT, statins, etc, yet still ended up with a double bypass last year after cardiac symptoms with exertion). So now there recent is a much stronger family pattern of diabetes at least in some of us, which to me suggests more recent environmental factors, epigenetic or perhaps expressing a genetic family trait not expressed in earlier generations.

My 11 yo son is now GF for just over a year (and does a good job being compliant as the unpleasant canker sores he now gets after gluten exposure are a good reminder). For the most part, he doesn't have access to highly processed foods at home, but now he's eating out of the home more often and probably isn't choosing what I would choose for him (candy, Slurpees, potato chips, etc.). And while he consumes a lot more natural fat, nutrient dense paleo and traditional foods, and a lot fewer empty sugar and starch carbs than most of his peers, I know he's choosing crap when he's with his friends. He'll definitely be a lot more aware than I was of a high carb diet, but eventually he'll be making all his own decisions (& hopefully not rebelling too much). I am acutely aware of how tastes and habits formed during childhood tend to persist in adulthood, but at the same time, his increasing independence creates new challenges we didn't have to deal with a few years ago when I chose nearly all his food.

Any thoughts on how much risk of diabetes he faces as he ages? I realize a lot of that is up to him, but I wonder how much might be strongly expressed regardless of his choices and environment? Given how my generation seems to develop diabetes at approx the same time as our parents (who are about 20-25 years older) how much might be genetic, environmental, epigenetic influences or a combination? Seems like the more I learn, the more I don't know (and my doctors don't know or don't have time/incentive to consider anyway).

March 6, 2010 | Unregistered CommenterAnother Anna

My morning numbers remain 100-115, after breakfast they go down to 98-ish, and after lunch and dinner up to 110-115 again. (I eat very low carb meals, sauteed veg and eggs or sausage for breakfast, salads and meat or cheese for lunch etc. Maybe one piece of fruit a day, some cream.) After my walk I can go as low as 60 and sometimes feel woozy. I used to work out very vigorously, but I had to stop because it would take me days to recover, now I realize I was probably making my blood sugar dangerously low.

I can't even imagine how I could get my fasting levels down to 80 and only rise to 90 after meals. Maybe focus on weight loss? Calorie restriction?

I actually wonder if I might not be better off like the fellow above: take a bit of metaformin, the occasional bit of insulin. Did you see the article about Metaformin at diabetes update? I just hope I have caught it in time, and that my beta cells and liver can recover. I am 40 yrs old, BMI of 25, and have a slew of strange health problems gradually resolving as I change my diet and get my vitamin D levels up. Eliminating gluten was huge of course, since I seem to have pretty bad nutrient deficiencies.

KGH

So you were 110-115 fasting on the SAD, up to 160 with a carby breakfast. Now you are 100-115 and you obviously are secreting enough insulin to go DOWN after a big protein meal, and you are even getting some reactive hypoglycemia after long walk? non of that sounds like T2 to me. You need a fasting insulin level and HBA1c - if they were normal I would even think about eating a few more carbs with each meal. What is your total carbs/day?

How long have you been VLC or LC vs the SAD? healing the liver takes some time.

March 6, 2010 | Unregistered CommenterRachael

Hey Dr. Harris,

Just curious, but why the Mg and selenium?

Also, what are you thoughts on iodine?

This article filled in some gaps for me as well, thank you.

KGH:

Common deficiencies easier to supplement for than to diagnose. See Stephan's latest pst on Mg.

Iodine coming soon.

March 6, 2010 | Unregistered CommenterDanny Roddy

This is a very interesting post for me. My close friend has both Type 1 and a gluten allergy. As I've started reading and learning about Paleo the last few months I've realized there's a lot of overlap between the Paleo approach and what she has learned on her own to manage her diabetes. However, without knowledge of the Paleo approach and basically only hearing the standard low-fat dietary message, she never made the leap to become full-on Paleo/Pa-Nu. Instead she's always had one foot in the SAD: avoiding gluten, and being moderate around sugar, and taking insulin after meals and so forth. I've been talking to her about Paleo and recommending she embrace it completely, but it's only been a few weeks since we've started discussing it and with her being about 25 weeks pregnant I'm pretty sure she doesn't want to make any drastic changes to what she's been doing almost her whole life.

So here's my question. Given her and one or both of her father and grandfather (I forget which) were also Type 1, I'm sure she is going to be very mindful about sugar with her child. But if I've read you correctly, you believe it's the undiagnosed/ignored gluten allergy that then develops into Type 1? I know you'd recommend avoiding wheat regardless, but is there anything else you'd recommend once her child is born to prevent it developing Type 1, given the family history and all? Is there a test that could be done so the parents and child can know if there is the likelihood for Type 1? In any case, I'm sure she'll be elated to know having her child prophylactically avoid wheat could prevent it from developing Type 1.

One last thing, she is very specific about avoiding gluten. For instance, I know she eats gluten-free baked goods: desserts, bread, etc. Any thoughts on gluten-free vs. wheat-free that I might suggest to her?

Sincerely, Allan

KGH: The beauty of PaNu is you are doing everything I can think of to avoid leaky gut autoimmune diseases. There is nothing more to do that I can see. You can lead horse to water....

March 6, 2010 | Unregistered CommenterPortlandAllan

Jan Kwasniewski has a fun comment on current diabetes treatment policies here:

"No hospital in the world is running a program to treat the cause of diabetes. That disease is considered incurable. No facts, not even the most spectacular and apparent, are able to make modern medicine change its view. I cured my first type 1 diabetic 30 years ago.
- Dr. Jan Kwasniewski"

http://homodiet.netfirms.com/otherssay/othersdiabetes.htm

Elsewhere I recall he claims that only one type 1 diabetic has NOT been able to get off insulin injections during his whole career. I try to find the exact phrase to back it up.

I personally cannot think a way how DM1 can be cured in most of the cases and can't really believe that Dr. Kwasniewski knows this either.

March 6, 2010 | Unregistered CommenterJohnny Bourdeaux PhD

Hey Dr. Harris, can I ask what form of selenium you're using? I've considered supplementing it before but I only remember finding selenomethionine, which I decided against after reading this on Masterjohn's site:

"Colpo reports a selenium trial that found a reduction in cancer and states that no adverse effects have ever been observed for selenium. In reality, this trial showed that selenium decreased the risk of cancer in the two-thirds of people who started out with moderate and low selenium status. In the third who started out with high selenium status, cancer incidence was 20 percent higher, although the effect could not be conclusively distinguished from that of chance. In the same top third, however, the risk of diabetes was definitely increased.

Personally, I think that had this study used selenocysteine, the animal form of the mineral, rather than selenomethionine, the form found in plants and yeast, and had other cofactors such as bioavailable cyteine (in the form of raw or undenatured proteins, n-acetyl-cysteine or vitamin B6), the supplementation may have proved beneficial even in the top third. But it certainly isn't correct to say that selenium has never been associated with adverse effects."

From: http://www.cholesterol-and-health.com/Anthony-Colpo-Great-Cholesterol-Con.html

Except I did find (and try out) Jarrow's methylselenocysteine formula, but it also contains broccoli seed extract which I was worried could be goitrogenic, and after playing with Fitday it didn’t seam like selenium was anything for me to worry about.

I’d love to hear any insight you could offer here. Otherwise it looks like I’m right with you on supplements, but I also take kelp capsules so I can’t wait to hear what you’ve got to say about iodine.

KGH: Selenomethionine

March 6, 2010 | Unregistered Commenterjustin

@Johnny Bourdeaux PhD

I read somewhere that Kwasnieski states that even though type1 diabetics supposedly have no insulin production,they all still secrete a very small amount.He wrote that he feels that type1 diabetes may be a defense mechanism to protect the body.Made sense when I read the post.So this is why when you put a type 1 diabetic on a VLC diet which is also VLprotein,they actually have enough insulin production to shuttle the low amounts of glucose in the blood.

KGH:

I agree more with Bernstein on this. IF you catch type I early enough you can get by with the residual insulin production on VLC as less insulin is required - I would add that if you catch it very very early and arrest the autoimmune reaction that Type I is actually reversible - it just does not happen very often that it is caught that early.

March 6, 2010 | Unregistered Commenterwolf

I definitely make insulin, like you say, breakfast makes my BG go down, and I have had problems with reactive hypoglycemia my whole life! My 2 weeks ago numbers were low carb, fasting at 115, pp at 160. Since then I have gone VLC and narrowed the window my blood sugar swings in. But I still go really low with the least provocation.

I should perhaps also mention that I have three children all of whom were over 9 pounds at birth even though they were less than 37 weeks gestation, and my youngest had a severe blood sugar crash at birth. I wasn't diagnosed with gestational diabetes, but something wacky was clearly going on with my pregnant self. Our pediatrician said my youngest was making enough insulin for the two of us.

Jenny over at diabetes update has lot's of links to studies showing fasting levels over 100 cause damage, and pp over 140 are also dangerous, My husband is 80 fasting, 85-90 after a meal, and back to 80 after a walk. My numbers look crazy next to him. Am I just over reacting? Is he just pancreatically gifted?

I have been moderate carb for about a year, previously I was an all-organic whole food crunchy granola vegetarian who sometimes ate fish. It turns out to be very hard to find anything to eat if you are both gluten free and a vegetarian. I was also eating very very low fat. Like 5% of calories tops. I haven't eaten a SAD in 30 years. It's a long story, I don't want to bore you. The punch line is, when I cut out gluten my health improved radically, but was still problematic, so I started looking for other answers. I actually think I was pretty severely fat deficient.

Do I correctly assume from the above that you think my numbers are reflecting physiological insulin resistance and I would be better off just eating more carbs? How long do you think it would take to get used to them again? Did I read somewhere that before I got a FOGTT I should eat at least 150 grm of carbs a day to get an accurate reading? Would you suggest going that high? Would a week give me an accurate idea?

I also have UARS/Sleep apnea, so it's possible my BG is up in the am because my stress hormones get a workout all night long. I have been off CPAP for about a year, the cost to my wallet, comfort, and sanity is currently more than the benefit of being on CPAP. Though it was a real life saver when I was first diagnosed.

Thanks so much for finding the time to answer my questions. I am so very happy to have found this community of people sharing their wisdom so freely. I have also gotten very kind advice from Petro at hyperlipid regarding my son's Familial Hypercholesterolemia. I appreciate it deeply. I totally understand that you can't treat someone you haven't seen. I am just trying to muddle my way through and appreciate any thoughts you might have.

KGH:

You have SAS which itself indicates you have metsyn and I have no doubt you had GD with those large babies. You have only been VLC for a few weeks - your liver and pancreas cannot recover that fast from grain heavy low fat vegetarianism. I would follow PaNu with carbs no more than 10% (about 50g) and limited to starches eaten with each meal. Work with a sympathetic local doc (ignoring his nutritional advice of course) and get your HBA1c and fasting insulin tested. These will help tell the story - DO a a home OGTT.

Home OGTT:

Eat at least 150 g carbs per day for three days, then do a breakfast challenge with three medium well-boiled (boil the hell out of them so they are easy to digest) white potatoes. Salt and pepper are fine but obviously no butter allowed! Recored sBG fasting, at meal end (eat them fast) and every 15 minutes for the next 3 hours or until sBG is back to baseline or below 100 or so. It is most accurate if you use three strips for each fingerstick and if two are close then toss the outlier -if not close average all three - fingerstick devices are wildly imprecise.

Report back with the results.

Give it some time but if all these tests point to impaired glucose tolerance and it does not improve in a few months, metformin sound reasonable. Work with a sympathetic local physician, but take cherge of the diet part yourself.

March 6, 2010 | Unregistered CommenterRachael

I have enjoyed this post and is great to read the shared output of everyone.

Just to point out about "Glucosamine", may be it is good for gut flora!! but mostly is used to improve join pains and is indicated as retarder of articular degeneration, BUT it is always WARNED that increases BG for diabetics as advese effect in the box!!!!???

March 7, 2010 | Unregistered Commenterthania

Dr. Harris:

In thin that when you say “… type I DM, the initial damage is caused by the hyperglyemia …”, you mean hyperglycemia, correct? I ask because there are so many slightly different terms for related conditions.

Diabetes type II seems to be associated with low levels of the hormone (actually considered a cytokine) adiponectin, secreted by body fat, with those low levels often preceding the onset of insulin resistance.

..............

KGH: I've seen that as you've already posted it on several of the other blogs. Yes, that's a typo - thanks.

I suppose "in thin" in your post is one, as well.

March 7, 2010 | Unregistered CommenterNed Kock

Dr.Harris,I wish I could find this post by Dr.Kwasnieski.I think it was from a forum but I just can't find it.As stated above by Johnny Bourdeaux PhD,Kwasnieski writes that only one person he ever cured with type1 diabetes needed insulin.As Peter from Hyperlipid says about Kwasnieski....he seems way out there yet what he says seems mostly to be true.Of course Peter worded it better. Maybe you could interview him?

March 7, 2010 | Unregistered Commenterwolf

> I suppose "in thin" in your post is one, as well.

Dr. Haris. I woud warnin youl thet makin tu mani tipos dosn’t maik yuy luk gud! Bi mor karefol, plise!

KGH: Priceless : )

March 7, 2010 | Unregistered CommenterNed Kock

It is discouraging that a diabetes journal is posting information about a study warning against low carb diets based on such incomplete data:

http://www.diabetesincontrol.com/index.php?option=com_content&view=article&id=9011&catid=53&Itemid=8

The point of this article is that low carb diets raise LDL cholesterol by 10 points--so are not as good as high carb diets which lower LDL by a few points. What about HDL levels? What about oxidized LDL levels?

KGH:

If your high fat diet does not raise measured LDL, you are probably doing something wrong. The lipid hypothesis will not die until its proponents do.

March 7, 2010 | Unregistered CommenterMike

The part about tsunami's of glucose arriving from the gut and insulin keeping them from putting you in a coma was too good, I cracked up over that.

I use stainless steel cookware, which is 18% or so selenium, and read a few papers demonstrating RDAish values of selenium leeking into food, particularly those cooked in acids.

Do you think additional selenium supplementation is warranted for people cooking with stainless steel?

Also, how does increased futile cycling of glucose in the liver factor into the type II diabetes liver damage paradigm?

March 7, 2010 | Unregistered CommenterChris D

Love the post. I'm still figuring my numbers. My fasting BG is 95 with an A1C of 5.8%. I suspect I am pre-diabetic or that Type II will always be the monster lurking behind the door for me.

On another note: I find the default font for your website is too small. I realize I can increase the presentation of text by changing settings on my browser, but thought I would let you know.

March 7, 2010 | Unregistered CommenterVictor

Dr Harris. First and foremost, thanks for all the work you are doing on your blog. I get in here and read as much as time permits. My younger brother is 28 and obese. He has been since he was about 10. I'm very concerned about his health. His extremities look swollen and painful, but he doesn't complain. He has tooth decay. He's fully mobile and works, but no one knows how much he actually weighs. My thought is that he's a ticking time bomb waiting for the results of decades long metabolic derangement to explode. He hasn't been diagnosed with Diabetes but I can't imagine that it's far off, if not already fully present.

I began following a strict Zone regimen after my last overseas deployment and found great success. Then I was introduced to Robb Wolff and went completely grain/diary free and continued to have great success. I'm incorporating your thoughts on VLC and continue to have great improvements by using Crossfit as my primary exercise methodology. I've converted half of my office mates and my family is coming on board with paleo nutrition. But, my little brother???

My question: is a standard paleo approach appropriate for my brother? Can you point me to the right resources that would allow me to read about nutritional approaches for the severely overweight? . Even pointing me to the right threads in your website would be a great help. I'm sort of what you could called free-time challenged.

KGH:

You said "Can you point me to the right resources that would allow me to read about nutritional approaches for the severely overweight?'

You are kidding, right?

March 7, 2010 | Unregistered CommenterSean R

No, actually. What I'm trying to get at is...is he potentially so far damaged that following the same exact routine that I am following would be dangerous?

KGH:

With the SAD, you are holding a blowtorch to your flesh. At what point would it be risky to turn off the flame?

It is never too late.

March 7, 2010 | Unregistered CommenterSean R

If you have a broken metabolism, with stubborn residual insulin resistance (liver, not adipocytes), or your leptin receptors are screwed up by WGA from wheat and your satiety switch is broken, or any of a number of theoretical metabolic derangements from years of eating the standard american diet, you may have trouble losing weight without going VLC (say 5-10% carbs) and you might indeed gain weight if you eat excess protein beyond your needs.

I think that it is my obvious lack of understanding of the ketogenic diet that prompted my question. I went back to the article that really prompted my post to find out what it was that game me cause to want to ask my question. First, I don't know that he has a broken metabolism, but it occurs to me that it's probably broken. If his isn't then I'd hate to see the guy whose metabolism is broken. Second, I'm concerned that I don't know what might happen with a sudden shift in his BG brought on by a big change in his diet...I obviously have no idea how diabetes works and am concerned that I could do more harm than good........maybe I just don't understand how universally applicable your advice is. If it's that simple, then I'll certainly be pleased. I'm a Marine, not a scientist.

KGH: Marines are all right by me. I read your initial question as asking me where to go when you are already there.

Your love for and concern for your brother are admirable.

I can think of no reason any human would not benefit from eliminating the neolithic agents we are not evolved to eat, nor any danger to stopping the damage at any point.

Using some common sense like transitioning into VLC is always good. Keep reading the blog.

March 7, 2010 | Unregistered CommenterSean R

I have seen one case this year of 'reversal' of type I DM - 14 year old male, put on paleo style diet - 4 weeks later, he no longer requires insulin. His doctor thinks his tests were wrong, so he repeated them with the same result. Then came to the conclusion that he must have misdiagnosed in the first place.
sample size = 1, but Ive seen it happen...

KGH:

I'd love to see more details including documented lab tests - this kind of thing should be published. You can send info via about me if you have Pt's permission.

March 7, 2010 | Unregistered CommenterSteve Ince DC

I don't think I am anywhere near to diabetes, but it just seems more sensible to me to eat a diet more in tune with how people evolved, and less influenced by the ease with which various crops are grown. Clearly wheat and grain crops are "good" in the sense that they help people avoid starvation, and bad to the extent that they are actively harmful to the gut, indigestible, and displace other foods that would be more beneficial to the organism as a whole.

If we are not near starvation, why eat things we know to be harmful?

I did read something interesting that I want to share, which was a study I saw in Dean Edell's book Eat Drink and be Merry (a reference not often mentioned on this site), and he notes in a section on saturated fat, as I understood his point, that when people were on a reduced saturated fat diet they increased carb intake and over-compensated or over-shot on required the caloric intake, leading to weight gain. That, I thought, was profound: It would explain the the initial weight gain, the horrible cravings people experience on low fat diets, and the usual failure of people who try to maintain the weight loss on those diets. People trying to maintain a weight or lose weight on a low saturated fat diet would be trying to do something simply beyond human endurance. And, of course, they would still be missing necessary nutrients in their diet.

I also wonder about the significance of the cravings people have for wheat and rice: it is as if the grains are addictive. (I do not see anyone exclaiming about how much they would miss eating potatoes...) You can explain the damage done and even the mechanism, and yet people will seek to justify the continued consumption of wheat, as if they were personally invested in wheat farms and wheat production. It reminded me of how it seems people will crave the very foods that produce an allergic reaction, or an addiction. It is always wise to deal with the emotional aspects of issues, because it is the emotions which provide the motivation for making decisions, and something odd is going on with a lot of people in these discussions. Or do they just fear change?

Thank you for your very interesting posts.

March 7, 2010 | Unregistered CommenterRichard

Kurt,

Thanks for telling me about your supplement usage.

I have a bias toward thinking in terms of "anti-inflammation" because of an old weightlifting injury to my sacroiliac joint.

Paradoxically or not, it was from doing deadlifts based on Mike Mentzer's Mind and Body II, so ken o'neill should find that more ammunition for his quiver.

Yet on Tuesday I will embark on Body by Science type training based on what I've seen in his videos and my past experience. Minus the deadlifts! Moving much slower. I'll try to track down a copy of his book in my local bookstores too.

Anyway, nutrition is more than fighting inflammation so I appreciate you sharing your preferred supplements with me. I will broaden my thoughts and think more in terms of supporting health, reasonably, than fighting a specific problem.

Finally your teachings are really starting to slowly teach in with me. I'm drinking coffee with actual full-fat cream now, something I haven't done in ages.

Your writings, Anthony "Dream" Johnson's, Nora Gedgaudas's, and both Doug McGuff and John Little's thoughts are forming a new way of looking at the world for me.

Prior to this I'd been drawn to the romanticizing our ancestors approach and trying to be like them. Maybe this held a special appeal to me because when I was 16, I lived 3 months mostly off the land, by myself, on Vancouver Island.

It was a wonderful experience and I even came back a lean, energetic young man despite having left on my journey as an obese, sullen boy.

I took the wrong lessons from this trip and got into long distance running and eating lots of carbohydrates. Injuries ensued, of course, and while I had fun running, it wasn't sustainable.

Getting a job as a "cook" at Dairy Queen for 2 years didn't help one bit either. That combined with my lack of knowledge and stubbornness hurt me. (Repeatedly trying an Anthony Robbins- type fruit-based diet, believe it or not, at the time which left me ravenously hungry and -- lo and behold -- I was in sugarville during these spells so developed terrible eating habits, worse even than my grain-based past.)

So the weight came back and I was more or less fat or at least chubby despite often high activity for years.

The weighlifting injury was the real nail in that particular coffin. I grew ignobly fearful of exercise and put on lots of pounds.

Well, to hell with that: Nothing ventured, nothing gained!

With some intelligent insights gleaned from you lot I intend on turning this around. I realize supplements are the last and least in terms of priority, but even this is challenging thinking I held that got me into this situation, and the new pathways of thought I feel coming about will pay dividends down the road.

I can't at the moment support you financially, but I do in spirit. Write a book and I'll buy it sooner rather than later. And thanks for taking a rational modern approach to looking at our ancestral heritage and metobolic systems... and deriving methods that are working for your patients, contacts, and readers in 21st century.

My one "on topic" remark is I believe diabetes would be much reduced if more people knew about your work and the work of your peers.

You're busy. Please don't trouble yourself to reply to this note.

KGH:

Thanks for your support and the great story - vancouver island would make a romantic out of anyone. I did a lot of mountaineering and rock climbing in my youth - I spent a few weeks climbing around the commander glacier in BC one summer.

March 8, 2010 | Unregistered CommenterChristoph Dollis

Is Elemental Selenium (Yeast) 200 mcg ok for type 2 diabetic controlled by Berstein low carb green veg/salad and protein (99% fullfat cheese because of poor digestion), no diabetic medication

Executive Chef Karen Barnaby from The Fish House, Vancouver, B.C. wrote Low-Carb Gourmet when she found the value of low carb for herself. See www.lowcarb.ca or Karen Barnaby.com

Looking forward to your iodine post (concerned re previous low salt diet, low fish/seafood diet, and processed food being too cheap to use iodized salt). I became hypothyroid (extreme incapacitating chills) after a decade of: quitting smoking, Candida systemic (digestion still very impaired), circadian switch, menopause weight gain, hypoglycemia (from lifelong sugar addiction), type 2 diabetic (genetic/maternal), severe depression (effexor etc ineffective), now low carb-normal weight-normal blood sugar but still low body temperature, discomfort even with 240mg desiccated.

KGH:

With 4 grains/day of dessicated you should be replete just with the iodine attached to the hormone.

Bet to make sure your selenium supp contains selenomethionine.

March 9, 2010 | Unregistered Commenterdlm

Aw crud. I just read that caffeine can raise blood sugar by 15%. And I do a lot of caffeine. I guess it's time for that to stop. Darn. This is going to be hard...

March 9, 2010 | Unregistered CommenterDave, RN

I love to see you dissing the ADA diet, and I wish someone from that organization would reply to this blog and give some kind of logical argument for their 55% carb recommendation for type II folks. I mean, these ADA guys can't be morons, I really want to understand their reasoning.

When I was searching for a protein:carb:fat ratio to shoot for (I'm not diabetic and want to stay that way), I found a study published in Nutrition & Metabolism in 2006 ( http://www.nutritionandmetabolism.com/content/3/1/16 ). U of Minn researchers reported that un-medicated type II diabetics put on a 30:20:50 ratio for 5 weeks (as opposed to ADA's recommended 15:55:30) reduced their fasting glucose to "near normal", and their 24-hour integrated glucose to 38% below the ADA diet. Certainly a strong argument against ADA's ratio, and ironic because the study was funded by the ADA! So why, 4 years later, are they still sticking with their high-carb diet recommendation? Do they just throw out studies that contradict the party line?

KGH:

I am as mystified as you are - human beings are fundamentally irrational, even in endeavors that are supposed to be based on science.

March 9, 2010 | Unregistered CommenterMike W

I am as mystified as you are - human beings are fundamentally irrational, even in endeavors that are supposed to be based on science.

So, Dr. Harris, do you feel you're heating up the planet like a hot girl in the back seat of a sports car with the captain of the football team and a fifth of vodka on prom night when you dare to use a plastic grocery check-out bag instead of bringing your own?

KGH:

I think destroying the economy to avoid the tiny contribution of AGW to the massive cycles of natural climate change during an interglacial where the next threat is really a new ice age is insane, if that is what you mean.

March 10, 2010 | Unregistered CommenterChristoph Dollis

Does a kid have to be fat to be at risk for diabetes? my little brother has such a poor diet, and my parents are not doing anything to change it. I'm so sick of it.

KGH: You can definitely get diabetes without being fat.

March 10, 2010 | Unregistered Commentertypes of diabetes

Dr. Harris,

After losing all my excess weight eating low carb (50 g) and 2 meals a day, I had a high fasting blood sugar test on a checkup. It was actually only 101. But I got my own glucometer, and saw that my daily blood sugars were often 115 and that my PPs could easily go way over 140 if I ate even moderate carbs. I read Bernstein and Jenny Ruhl and went even lower carb following Dr. B's limit of 12g per meal. But I couldn't get my blood sugar down below 100. After almost two years of that, in desperation, I increased my already high fat diet to as much fat as I could eat without throwing up (90 -95%). My BG went down to the 90's. It has stayed that way. But I gained 10 pounds that I cannot seem to lose even though I have dropped my fat intake back to my normal high fat level. I am eating two meals a day withing a 5 -6 hour window.

Any thoughts?

KGH: What is your A1c and what are your pps?

March 10, 2010 | Unregistered CommenterEllen

My fasting blood sugar level hovers around 90/95, and will go to 110 after meals. My HbA1C is 5%. I think that is pretty normal for very low/ ultra low carb intake (sub 40g day) for me. The A1C tells me the "elevated" blood sugar level is just fine.

Non-diabetic, male, 41 years old, 12/14% body fat, eating a Paleo (zero sugars, grains, dairy, industrial oils) diet with sub 40g carbs per day (winter pattern of eating) summer and fall see me eating a bit more starchy foods and berries, perhaps to 80g of carb per day.

KGH Sounds fine with that A1c.

March 10, 2010 | Unregistered CommenterTim

That's exactly what I mean: Well put.

March 10, 2010 | Unregistered CommenterChristoph Dollis

KGH: What is your A1c and what are your pps?

Ellen: I had an A1c a year ago. It was 5.4 . the fasting BG from that same draw was 126. That was higher than normal for me at that time as my home tests were averaging 110. My meter may have been somewhat lower than theirs but I am guessing that the 5.4 Alc is in line with my home blood sugars and if they were really much higher, I would have had a higher A1c. Or is that a bad guess?

In any case I have been thinking I need to do another A1c with my now lowered fasting numbers. But won't be going back to that doctor because he only wanted to give me statins, had no interest in the fact that the testing showed I had reduced my sdLDL drastically by IF and low carb and I got high blood pressure just from walking in there. Ooops, sorry for the rant.

With the way I eat 99% of the time my pps go like they did today: 97 fasting, 109/ 45 minutes after, 96 1 hour, 89/ 2 1/2 hours later.

I usually don't measure pp since they seemed to me to be okay as long as I ate right, but today took them every 15 minutes out of curiosity.

(I really want to lose those ten pounds before my upcoming 50th!!! high School reunion. But if they are the cost of the lower blood sugar, I will take that deal. I just don't understand why that would be.)

KGH:; your pps and a1c sound fine

March 10, 2010 | Unregistered CommenterEllen

KGH:; your pps and a1c sound fine

Yes, I think so too. What is curious is that I had to gain weigh to improve them. Not the way it is supposed to work.

Ellen

March 10, 2010 | Unregistered CommenterEllen

Dr. Harris...I've been eating a LC paleo diet for several months now. I've cut out all grains, legumes, sugar, processed food, most starch except for an occasional sweet potato or acorn squash, and I eat about 12-16 oz of meat per day along with plenty of animal fat, pastured eggs, butter, cream, cheese, nuts, leafy greens, berries and an orange or peach from time to time. Daily carb count approximately 40g. Macro nutrient ratio 65/25/10 fat/protein/carb.

Out of curiosity I recently had my BG and HbA1c tested. My 12-hour fasting BG was 105 and my HbA1c was 5.3. Now by my starting weight and abdominal fat it's highly likely I was insulin resistant in the liver. I consumed a lot of sugar and n-3 over the years so it's not surprising. My question is this: how long should it take before I see a fasting BG in the 80's and an HbA1c below 5.0?

KGH: Maybe forever. My HBa1c is 5.8 even though my average sBG over 24 hrs predicts it would about 5.2

You need to test sBG especially post-prandial, throughout the day to know more. but 5.3 is hardly pathologic.

March 10, 2010 | Unregistered CommenterDerek S.

Oops...I meant a lot of n-6, not n-3.

March 10, 2010 | Unregistered CommenterDerek S.

This is my first posting, and I'd like to say how much I appreciate the material on this blog. I have received three kidney transplants over the past 27 years, and have been on immunosuppressants and prednisone most of that time. My brother is Type 1. I developed steroid-induced diabetes after my first (1983) and third (2004) transplants, but was able to stop the insulin after a few months each time. In 2008 my A1c jumped to 7.7 and I started insulin again, but stopped it and have been able to keep my A1c at 6.6-6.8 with dietary changes without BG meds or insulin. After reading Dr. Bernstein's book in January, 2010 I drastically changed my diet, and it now largely conforms to what is recommended on this blog (still a work in progress though). I'm now waiting to see how my next A1c comes out. My fasting BGs run from 85-125 (average 110-115) and my 1 hour PPs are highest after lunch (140-160) because of the cortisol spike from my morning prednisone.. My BMI is 23.

But here's my question: I've worked hard over the past year with a naturopathic doctor to get my lipid and inflammatory markers in line. Kurt, I surmise that you don't put much stock in lab markers except for testing insulin and BG levels. But when my lp(a), LDL A/B particle size, HDL, CRP, hsCRP, homocysteine, fibrinogen, and ADMA levels are all good to excellent, doesn't that stand as an accurate sign that the most damaging RESULT of higher than normal BG and insulin levels--that being inflammatory damage to the endothelium (in the liver and elsewhere)--is at least somewhat under control? Kurt, do you allow that these tests stand as some kind of valid indication of pathological activity in the body, even after admitting the deleterious effects of high BG and insulin? I've got to think that two people having the same BG/insulin levels but with drastically different cardiovascular markers are in very different situations. Needless to say I have to be very careful because of the potential for harm to my transplant from elevated BG and insulin. As of now I have no microalbumin in my urine.

March 10, 2010 | Unregistered Commenterstevehecht

Looking forward to your post on Mg and how it relates to everything. One of the things that getting off the SAD has not cured for me is occasional constipation. I've tried all sorts of things. Mg citrate supplementation and yogurt are the only things that seems to help. Even if I eat lots of foods high in Mg, it doens't help like the supplement.

March 11, 2010 | Unregistered Commenterzach

Hmmm, excess glucose stacking up in the blood causing thrombogenisis... could
a 4 day Christmas sugar binge cause thrombosis to develope?

I had a pulmonary embolism resulting from a thrombus for which no cause could
be found, even after extensive testing.

I have been pretty much sugar abstinate for the last 5 years except last Xmax
when in let loose and my 4 days of madness.

Is there any conceivable way that this could have triggered or altered the
blood clotting process? (BTW, my lp(a) is way up at 900 mg/dl)
had my 4-day madness

KGH:

If lp(a) is as high as 900 there is something going on.

So sugar is fine (you say) but what is your PUFA consumption these past 5 years? Have you been avoiding sat fat by any chance?

March 16, 2010 | Unregistered CommenterScott Hamilton

You're saying "insulin talking to the liver" is just a metaphor, but I thought that that is actually what is going on?

KGH:

It is metaphor, as they are not using verbal speech. Good Grief!

March 17, 2010 | Unregistered CommenterTim

No I haven't been avoiding "satch", have been trying to use coconut
oil in place of saturated fat from grain-fed beef just to make sure that
the SFAs that I am getting are not adulterated by modern production
methods.

I do take fish oil capsules and try to avoid vegetable oils where ever
possible and also avoid sugar and refined carbohydrates like the
plague.

I thought I could then have my sugar binge once a year at Christmas
but perhaps this wild swing in my macronutrient intake may have
provoked the thrombosis which occurred a few days later.

The article mentions "thrombogenesis" as a side effect of sugar
consumption if I understood correctly and thought maybe this might
have been involved in my case.

Scott

March 17, 2010 | Unregistered CommenterScott Hamilton
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