Now why didn’t I think of that???

Nobody is terribly surprised that Food Network star Paula Deen has diabetes, but the interesting thing is how many people assume that she has developed diabetes from overindulging in fat and sugar, and that the real culprit is fat.  Her son has a new show called “Not Mama’s Cooking” where he “makes over” Paula’s recipes, often by lowering the fat and increasing the carbs.  Sigh . . .   

 Those of us who have read books like Gary Taubes Good Calories, Bad Calories, and who have paid attention to the latest research which shows that fats, formerly thought to be the major contributor to obesity and disease,  is NOT the culprit.  We believe that the carbohydrates in Paula’s diet of choice—all the carbohydrates—are a major factor in her diabetes.  (Genetics may play a part as well, but it’s the carbs that cause the genetic predisposition to turn on the diabetes “switch”.)

 Marion Nestle, of Food Politics, posits, in today’s San Francisco Chronicle Food Matters column, has yet another theory of why Paula Deen and many others develop Diabetes Type II–because they are overweight.  Nestle points out that 85% of people who develop diabetes type II are obese, therefore, she concludes, that must be the cause. 

 She doesn’t quite manage to state what might cause Diabetes Type II in the other 15% of individuals who are not obese, although she does give a passing nod to “genetics”.

 And to Nestle, the prevention for Diabetes Type II is simple.  Lose weight by eating less and moving more.  She urges that old balanced diet—one where carbohydrates are “balanced” with the fat and the protein.  She particularly recommends against cutting back on carbohydrates alone. 

 ZZZZZZZZZZZ, same old, same old!

 I wonder about people who believe that this is the simple answer to this 21st century diabetes scourge.  Presumably the word is out.  Everyone who doesn’t live under a rock has heard the conventional wisdom–eat less and move more and you won’t get fat, or if you do, that’s the secret to losing the excess weight.  What puzzles me most is that people who think losing weight is that simple must think that EVERY obese person has not tried that, or at least not tried that “hard enough”. 

 How can they believe that?  I can almost guarantee that every single overweight person has tried at least one (and often many) calorie reducing diet and has exercised “more”.  Some people complain that their obesity developed while they were exercising religiously and following a low calorie, whole grain diet. 

 News Flash:  Eat less move more does NOT work.  If it did work, if it was that simple, why do you think we all got so fat?  The answer, is obvious–we are all a bunch of stupid and  lazy slobs.  What else could explain the obesity epidemic if the solution is so simple.????

 Nestle touches on the issue of insulin resistance, but states that insulin resistance is a consequence of obesity.  She fails to recognize that insulin resistance can (and probably does, in most instances, as posited by Gary Taubes) CAUSE obesity, not the other way around.  Many people are insulin resistant though still very thin.  Dr. Mary Vernon refers to these people as “metabolically obese” even when their bodies are not (yet) overweight.  Poor diet is certainly one reason for insulin resistance, genetics may also play a role. In any case, it’s clear that insulin resistance may be the precursor to obesity, not the other way around. 

 In my case, for example, I have a condition called “Polycystic Ovarian Syndrome” (PCOS), which we now know is a metabolic condition, the hallmark of which is insulin resistance.  I was a terribly thin child (a lousy eater) and thin young adult (with an abysmal diet!).  Nevertheless, I had PCOS, so that even in the very beginning when there was not an ounce of fat on my body,  my menstrual cycles were severely impacted (1 to 2 periods per year, no ovulation, infertility).  I weighed 110 pounds soaking wet when I got married, and we underwent three YEARS of infertility treatments before I could conceive my first child through in vitro fertilization.  The hormone treatments for infertility made me pack on the pounds so that I came out of all that treatment after my first child was born 70 pounds heavier and continued to gain from there.  Appalled, of course I tried to rein in my diet by eliminating fats, eating plenty of vegetables and whole grains, and adopting various exercise programs.  Yet I grew more and more obese. 

 In the year 1999, I read about the new theory that PCOS was tied to insulin resistance and that a low carb diet coupled with the oral diabetic drug Metformin was helping people normalize their metabolisms and in some cases, even conceive naturally.  I was lucky to secure a referral to a great endocrinologist who understood all of this.  He put me on Metformin , which is an insulin sensitizing drug, and advised me to follow a low carb diet outlined in the book by Michael and Mary Dan Eades called Protein Power.  The weight practically flew off, even though I was eating a delicious diet consisting of plenty of FAT and protein–butter and heavy cream daily.  And, to my utter surprise (and great delight) I got pregnant with my second child “naturally”.

 Insulin resistance caused my PCOS, not the other way around.  By lowering my carbohydrates and increasing the fats, my insulin resistance decreased.  The PCOS symptoms abated.  I lost weight, and was able to conceive. 

 Nestle doesn’t get the dietary connection to insulin resistance.  She blames insulin resistance on weight, and erroneously concludes that weight loss will improve insulin resistance (I was just as insulin resistant at 110 lbs as I am at 220). 

And how does Nestle propose that someone lose weight to improve insulin resistance and manage Type II Diabetes?  “Dietary advice for type 2 diabetes is the same as advice for everyone else: Eat a wide variety of relatively unprocessed foods, especially vegetables, fruits and whole grains, and don’t consume too much junk food or too many sugary beverages.

 Scientists may argue endlessly about the relative importance of calories, sugars and refined carbohydrates in the diets of people with type 2 diabetes, but everyone agrees that eating less of all three would help resolve symptoms.”

 Well, Scientists may argue, but a growing number of clinicians like the Eades, Atkins, Vernon, Westman,  Rosedale, Pescatore, Davis, and many others agree that carbohydrates DO matter and they see the results every day in their clinics.  Reducing carbs controls insulin resistance. Their obese and diabetic  patients lose weight, improve their lipid profiles, and are able to get off their diabetes medication.  They also can get off blood pressure medications, statins, and proton pump inhibitors, simply by reducing dietary intake of carbohydrates AND increasing fat. 

 Nestle says that “some people” who follow her advice to eat less, move more will “still need medications.”  What she fails to recognize is that a whole lot fewer of them will need any medication at all if they reduce the carbohydrates in the diet and  stop eating grain.  And to do that successfully, protein and especially FAT must increase.  “Balancing” carbohydrates  is ludicrous and ineffective.  Carbs must come down, fat must come up.   Calories tend to take care of themselves when insulin resistance is minimized so that the body can absorb nutrients properly while shedding excess fat.

 Nestle understands that diet is key, even if she doesn’t get what type of diet is effective.  She states that she was a speaker at an ADA conference and she was one of only two speakers at the entire conference addressing diet at all, the other speaker was sponsored by Coca Cola and speaking about sugar (!?!–let’s give the fox the keys to the henhouse!).  Nestle  gets the fact that the big pharma sponsorship of the ADA is a huge conflict of interest.  But unless and until she understands that reducing carbohydrate consumption is the key to treating insulin resistance and preventing or reversing diabetes, her advice is nothing more than the conventional wisdom that simply does not work.

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5 thoughts on “Now why didn’t I think of that???

  1. Wow. I just clicked to your site from the Fat Head site and was amazed to read of your PCOS. I’ve been doing research insulin resistance and idiopathic hirsutism. My doctors believed that I had PCOS but my testosterone/progesterone levels fell within normal ranges, my periods were regular, and after three pelvic ultrasounds no sight of cysts in my ovaries. Doctors wanted to put me on either birth control or spironolactone–I refused because I didn’t want to affect my hormones any further (little did I know my hormones were affected by lack of fat). I’ve been on low carb/high fat for three weeks and wouldn’t you know it, my hirsutism is changing. I like you, believe insulin resistance is the culprit. I wonder what health complaints aren’t the result of insulin resistance & carbs.

    • PCOS is a syndrome and it is not necessary to show all of the symptoms to have the diagnosis. For example, I do not have hirsutism. And at least 50% of women with a confirmed diagnosis of PCOS do not have cystic appearing ovaries (although that seems to change at different stages of life–when I was on fertility drugs they did appear to be more cystic). And not everybody is obese (I was thin for a long time!). The definitive test for PCOS used to be the LH/FSH ration. Testosterone and progesterone vary depending on where you are in your cycle. My testosterone was sky high (for a woman) but I didn’t really cycle. Another good test, but you need an endo who knows what s/he is doing, is C-peptide–this has to do with insulin metabolism.

      BCPs can exacerbate PCOS, particularly the tri-cyclic ones they used to use. Primary care physicians don’t always understand that the TYPE of BCPs is important to consider. Symptoms are suppressed while on the BCP’s but may be even worse when you come off them, especially if you are then trying to conceive. Some people have had good luck with the Yasmin type of BCP’s — I don’t even know if those are still available because I’ve been out of that loop and I hear commercials about class action suits concerning side effects of Yaxmin in particular.

      There also seem to be some distinct types of PCOS, although most doctors would not recognize this (this is more my theory from reading and talking to people with PCOS). People with more adrenal issues than insulin resistance do seem to respond to spirolactane. But I think most (if not all) women with PCOS are insulin resistant, and a low carb or Paleo diet will help immensely. I also take Metformin.

      Keep on reducing carbs and refeeding with plenty of healthy fats. If you are still having symptoms, the spirolactane will still be there if you decide to try it.

      Yes, it is amazing that so much seems to be related to insulin resistance. Imagine how much the nation’s health care costs might be reduced if this was better understood by physicians and the correct dietary advice was given out.

  2. Thank you for your reply. I’ve yet to get results from my blood work to see what my triglycerides/HDL numbers are. In 2010, my TRI/HDL (161/41) ratio was 3.9; prior to that its was consistently at 3. I may consider finding me a good endo. The MD who mentioned hirsutism didn’t really probe far (and she left the practice before I could ask her anything); and my current DO wasn’t too impressed with my triglyceride numbers to suggest anything except the spironolactone in a kind of cookie cutter method of finding what’s wrong with me (you know, here’s a pill and see if it makes a difference). My triglyceride numbers have been borderline high (150, 150, 161) but I guess never high enough to sound an alarm–is this really preventive medicine?

    what you say here: “There also seem to be some distinct types of PCOS, although most doctors would not recognize this” makes sense to me–every body/woman is different–at least that is what I get from this. Every story is different. I link my hirsutism back to age 25 after I started a low fat diet (remember Richard Simmons Deal a Meal?) and I lost 25 pounds–no other typical PCOS symptoms except being overweight (but as you said, at 110 lbs your cycles were affected). BCP (for contraception only) did nothing for facial hair. I’ve been off BCP for seven years. Never tried to conceive so I can’t really speak to that. I’ve led a mostly vegetarian/low fat lifestyle for 12 years and hirsutism and everything linked to high carbs and insulin resistance has plagued me for as long (depression, anxiety, weight gain, fatigue, bloating, IBS, GERD, forgetfulness or inability to concentrate). I believe insulin is missing link. But, I have a few questions for my future doctor or endo. I was actually beginning to believe and accept that I was going to grow older with a lovely beard–I would be quite the eccentric. Until eating fat changed all that.

    So far I’ve been enjoying my high fat diet and protein packed breakfasts. This has been an incredible journey so far. Thank you for sharing your story, it keeps me inspired to continue my research.

  3. I found my way here from Andreas Eenfeldt’s blog. You’ve probably already seen his interview of Dr Michael Fox (reproductive endocrinologist) which concerns the connection between metabolic syndrome / insulin resitance / infertility / PCOS. Dr Fox puts all his patients on a strict low carb diet (augmented by medication, I think – probably metformin or similar) and he reports extraordinary results. He says that only a small minority end up needing IVF. It’s a really interesting interview (and overlaps with a lot of what you wrote above). In case you haven’t seen it, here’s the link:

    http://www.dietdoctor.com/how-to-eat-to-get-pregnant

    • Yes, that was a great interview with Dr. Michael Fox! In the early 1990’s when I was trying to conceive my first child, the metabolic connection was not recognized–fertility drugs or a barbaric ovarian wedge resection were the only things recommended (how scary is this–they knew wedge resection sometimes worked, but they didn’t know WHY!). Even in the year 2000 when I pursued Metformin and a low carb diet only to improve my overall health, it wasn’t well recognized that was really effective for infertility. I was 41 and had given up on having more children (though I really wanted more) and when my great endo put me on Metformin he told me I could get pregnant. I thought that was a hilarious joke!

      The upsetting thing to me is that few fertility physicians are addressing the metabolic syndrome as comprehensively as Dr. Fox and his associates. Women with PCOS may be told to lose weight, but few fertility physicians recommend a low carb diet, and if they prescribe Metformin on a standard low fat, high carb diet, many women can’t tolerate the GI side effects caused by carbohydrate intake, so they give up on Met or may take newer insulin drugs with less safety. Or they are given fertility drugs and invasive fertility treatments that make a lot of money for the doctors with poorer track records for “live birth” success.

      Congrats on finding this way of eating and seeing the results! Just last week I took my 11 year old to an on call pediatrician because she was sick. The pediatrician looked at her acne and asked if she’d started her period. I explained that she had not and she has the blood markers plus acne indicating PCOS. The doctor said that she could not have that because she is not obese. That just shows how ignorant doctors are and the scary part is that probably 10% of her adolescent girl patients have it but she won’t recognize it in many when intervention might be more effective. Grrrrr.

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