Polite requests, Part 2.

Having had a polite request from someone with T2DM, I hereby disengage from trading insults.

Time to disengage.

Sometimes, when a lot of mud gets flung, some of it can stick to the wrong people.

Lifestyle-induced metabolic inflexibility and accelerated ageing syndrome: insulin resistance, friend or foe?

Serendipity strikes again!

The tipping point and the metabolic syndrome.

The picture that I used for the last post came from Lifestyle-induced metabolic inflexibility and accelerated ageing syndrome: insulin resistance, friend or foe?

Fascinating stuff!

Metabolic flexibility - do you have it?

I'm not quite sure what the picture below means (I need to do a spot of reading!).

Metabolic flexibility "bowl" and "Adaptability envelope"

While replying to Kade Storm this morning, it suddenly occurred to me that the Eskimos have an unusual ability. RER (a.k.a. RQ) normally varies from 0.7 (100% fat-burning) to 1.0 (100% carb-burning aerobically) to >1.0 (100% carb-burning, some anaerobically). Eskimos manage to get an RER of 0.600 *Mind blown.*

One theory that comes to mind is BAT. As Eskimos live in a very cold environment, it's possible that this has resulted in them having a large amount of BAT. BAT is very metabolically-active and turns ATP into heat via UCPs.

Nowadays, first-world people don't live in a cold environment (unless they're old and/or poor), so we don't have much BAT after infancy. Naturally-skinny people may be that way due to having more BAT. They seem to be able to eat whatever and as much as they want without getting fat. I would like to scratch their eyes out!

Not exactly rocket science, is it? Part 2

If there's a deficiency in "X", taking supplement "X" will correct the deficiency in "X".
If problem "Y" is caused by a deficiency in "X", then taking supplement "X" will fix problem "Y".

If there's no deficiency in "X", taking supplement "X" won't do anything.
If problem "Y" isn't caused by a deficiency in "X", then taking supplement "X" won't fix problem "Y".

If a person spends a lot of time outdoors in skimpy clothing in sun that's higher than 45deg in the sky, it's highly probable that they will not be deficient in Vitamin D3. Therefore, supplementing with 5,000iu/day of Vitamin D3 will highly probably do nothing.

If the above person has type 2 diabetes, supplementing with 5,000iu/day of Vitamin D3 won't fix their type 2 diabetes.

Not exactly...

Rocket Science!

There will be some people for whom all of the supplements & exercise that I recommend don't help their type 2 diabetes. Sorry about that. A low-carb (but not very-low-carb) diet will minimise your serum glucose level fluctuations without increasing your serum NEFA level excessively. See The problem with Diabetes.

I'm Disqus'ted!

It's been 4 days and my Comments Import Status progress is still 0.0%.

It's so unfair!

Yes, I'm trying to migrate my comments over to Disqus. It works well at
http://carbsanity.blogspot.co.uk/. I can see who's replied to my comments and I can also edit my comments.

Can supplements & exercise cure Type 2 diabetes?

Definitely, maybe!

From http://health-in-hand.co.uk/2013/03/24/supplements-for-the-non-supplement-takers/

According to Hyppönen and Power, in a large sample of the white British population born in 1958, 60.9% of subjects had serum 25(OH)D (the active metabolite of Vitamin D) of less than 75nmol/L in Summer & Autumn, and 87.1% had serum 25(OH)D of less than 75nmol/L in Winter & Spring. 75nmol/L ≡ 30ng/mL.

 From Hypovitaminosis D is associated with insulin resistance and β cell dysfunction, 2-hour post-load blood glucose level in an oral glucose tolerance test (OGTT) has a negative correlation with 25(OH)D concentration (Fig 1C). 25(OH)D concentration has a positive correlation with insulin sensitivity (Fig 2A). Therefore, 2-hour post-load blood glucose level in a OGTT has a negative correlation with insulin sensitivity.

"Extrapolation from the observations in the current study suggests that increasing 25(OH)D from 10 to 30 ng/mL can improve insulin sensitivity by 60%, from 3.8128 to 6.1176 (umol/L)·m-2·min-1·(pmol/L)-1. This improvement in insulin resistance could potentially eliminate the burden on cells and reverse abnormal glucose tolerance. Furthermore, the 60% improvement in insulin sensitivity that results from vitamin D treatment indicates that that treatment is more potent than either troglitazone or metformin treatment (54% and 13% improvement in insulin sensitivity, respectively). The modest effect of vitamin D on insulin sensitivity in individual persons may translate into a dramatic effect in the population as a whole because of the high prevalence of hypovitaminosis D, which, in a large population, carries an attributable risk for type 2 diabetes and the metabolic syndrome. Although a review of the literature suggests non-calcium-mediated effects, the underlying molecular mechanism remains to be elucidated."

As my 2-hour post-load blood glucose level in a OGTT became low (3.7mmol/L, from 8.7mmol/L in 2003) after supplementing with 5,000iu/day of Vitamin D3, this means that my insulin sensitivity became high. Therefore, I cured my pre-type 2 diabetes using supplements.

My fasting blood glucose level also fell from 6.8 mmol/L (> 7.0mmol/L = type 2 diabetes diagnosis) to 5.0mmol/L. I achieved this without taking any drugs for type 2 diabetes - not even Metformin, which I consider to be a safe & effective insulin-sensitiser, though it can cause gastric distress and B12 absorption issues, long-term. The supplements that I took had zero side-effects and merely corrected deficiencies.

Diabetes drugs cannot cure type 2 diabetes. However, supplements & exercise can cure type 2 diabetes, if the type 2 diabetes is caused by nutrient deficiencies and/or sedentary behaviour and if all pancreatic beta cells haven't been destroyed. Insulin injections can preserve pancreatic beta cells, while insulin resistance is being tackled. See Dr. Richard K Bernstein on insulin for type 2 diabetics, and some definitions.

Sadly, if there are no nutrient deficiencies and/or all pancreatic beta cells have been destroyed, supplements & exercise will not help.

Ketogenic diets - when they're not ketogenic.

High in the Arctic, Eskimo!

It's generally assumed that eating less than 50g/day of carbohydrate results in ketosis. Assume makes an ass out of "u" and "me". From Lyle McDonald's book The Ketogenic Diet:-

The Ketogenic Ratio (KR) = K/AK, where K = Ketogenic stuff and AK = Anti-ketogenic stuff.

K/AK =  (0.9*Fat + 0.46*Protein)/(1.0*Carbohydrate + 0.1*Fat + 0.58*Protein) where Fat, Protein & Carbohydrate are in grams.

For the treatment of epilepsy (very strongly ketogenic), K/AK must be greater than 1.5. For people who want to get into benign dietary ketosis, K/AK can be lower.

Eskimos eat a diet containing virtually zero dietary carbohydrate (~50g/day as muscle & liver glycogen). However, they are not in ketosis. See STUDIES ON THE METABOLISM OF ESKIMOS.

Eskimos eat so much protein that the Anti-ketogenic effect of Protein offsets the Ketogenic effect of Fat + Protein. Table IV is interesting, as it shows how much energy is lost as ketones on the third day of successive fasts in non-Eskimos (Subject #1 fasted once only). Note:- Beta-hydroxybutyric acid  produces 5kcals/g.

Subject #1:- 10.5kcals. ?kcals, ?kcals.
Subject #2:- 100.5kcals, 7.0kcals, 2.75kcals.
Subject #3:-  9.75kcals, 0.0kcals, 0.0kcals.

The answer is "not a lot" (except for Subject #2 on the first fast).

New treatment might put Type 2 diabetes in remission.

From:
http://www.ctvnews.ca/mobile/new-treatment-might-put-type-2-diabetes-in-remission-1.806064
"A new study by Toronto researchers on a new way to treat type 2 diabetes shows it may cause temporary remission of the disease in up to 75 per cent of patients.
 
The new treatment involves taking four shots of insulin -- the medication required by some diabetics to control blood sugar levels -- per day for just one month. This is a change from the usual treatment, which involves daily insulin shots over an extended period of time.

Patients develop diabetes when their pancreas can't produce enough insulin to lower blood sugar levels after meals. While medications can temporarily boost insulin production, many type 2 diabetics face a lifetime of daily insulin shots. Over time, patients with the disease can go on to suffer from a range of complications including blindness, heart disease, kidney problems and nerve damage.

Dr. Bernard Zinman, the director of the Leadership Sinai Centre for Diabetes and lead researcher of the study, explained how the new treatment works to CTV News. According to Zinman, by giving type 2 diabetics concentrated levels of insulin for a month early on in their disease, their pancreas, in effect, gets a "a break."

"The diabetes in essence goes away because their own pancreas now can make enough insulin," he said.

After the month on concentrated doses, patients are required to take another type of medication to "maintain" the remission, said Zinman.

Zinman said that the period of remission may eventually wear off, and so he sees the possibility of a future "top-up" treatment, which would last another month.

While the remission period can vary in patients, the prospect of improving pancreatic function is an exciting development in diabetes research, said Dr. Ravi Retnakaran, co-researcher of the study.

"This is a very novel and exiting way of treating diabetes that could have important implications," said Retnakaran.

For patients involved in the study, the treatment has had a major impact on their quality of life. Francoise Hebert was diagnosed with type 2 diabetes in November 2010. Seven months ago she enrolled in the study, and while she found the four daily insulin doses challenging, her blood sugar levels are now normal.

Hebert now happily tells people she "no longer has the disease," and enjoys knowing she's delayed any progression of diabetes-related complications.

"It feels fabulous," she said with a laugh. "It feels absolutely wonderful."

In addition to having her diabetes go into remission, Hebert says she's also learned how to eat better and hopes to eventually be able to get her weight under control.

Type 2 diabetes is primarily caused by an unhealthy diet and physical inactivity.

The research team at Mount Sinai Hospital hopes to have study results in a year or two, as well as more safety data on the medication."

What the world eats -- a week's worth of groceries.

I saw http://imgur.com/a/mN8Zs on Twitter.

Britain

USA

Chad

Hmmm. Have you spotted the "elephant in the room"?

My missions.

I was once asked:- "That is my cause, that is my mission, what is your cause Nigel ? What is your mission ?"

My reply was "Anyway, my mission is to disseminate (hopefully accurate) information about Diet, Nutrition, Fitness & Random stuff in a way that’s interesting to the lay public – hence the videos and pictures."

Information. We want information...

I am not a number. I am a free man!

My primary mission is, as stated above, to provide free information of high quality in a form that you can easily understand and to support that information with high quality evidence.

I believe that you don't want to read too much techy stuff, no matter how fascinating it may be to me!

My secondary mission is to expose misinformation. I am like The Terminator. I vill not stop. Eva!

Hasta la vista, baby!

Diogenes: High protein + low GI = Weight-loss maintenance WIN.

See Diets with High or Low Protein Content and Glycemic Index for Weight-Loss Maintenance.

LP = Low Protein. HP = High Protein. LGI = Low GI. HGI = High GI.

"In conclusion, in this large, randomized study, a diet that was moderately high in protein content and slightly reduced in glycemic index improved the rate of completion of the intervention and maintenance of weight loss and therefore appears to be ideal for the prevention of weight regain."

Note that Low GI isn't the same as Low carb. The Low GI diets had ~43% of total energy from carbohydrate. The Low GI diets were not Low carb diets. They weren't as High carb as Healthy Eating Guidelines (55% of total energy from carbohydrate).

Polite requests, Part 2.

Having had a polite request from someone with T2DM, I hereby disengage from trading insults.

Time to disengage.

Sometimes, when a lot of mud gets flung, some of it can stick to the wrong people.

The most simple tip to lose weight EVER is “Eat less and move more”.

Said Gaz at Cycle Of Life - Fix You.
He went from this...

Not a happy bunny.

To this...

A happy bunny.

Now tell me that ELMM doesn't work!

Hypoglycaemic counter-regulation at normal blood glucose concentrations in patients with well controlled type-2 diabetes.

Hat tip to Graham of the Lowcarb Team. See Hypoglycaemic counter-regulation at normal blood glucose concentrations in patients with well controlled type-2 diabetes.

"Background

Intensive treatment to achieve good glycaemic control in diabetic patients is limited by a high frequency of hypoglycaemia. The glucose concentrations at which symptoms and release of counter-regulatory hormones takes place have not been studied in patients with well controlled type-2 diabetes.

Methods

We studied seven well controlled, non-insulin treated, type-2 diabetic patients (mean HbA1 [corrected according to Diabetes Control and Complications Trial] 7·4%, SD 1·0) and seven healthy controls matched for age, sex, and body mass index with a stepped hyperinsulinaemic hypoglycaemic glucose clamp. Symptoms, cognitive function, and counter-regulatory hormone concentrations were measured at each glucose plateau, and the glucose value at which there was a significant change from baseline was calculated.

Findings

Symptom response took place at higher whole-blood glucose concentrations in diabetic patients than in controls. Counter-regulatory release of epinephrine, norepinephrine, growth hormone, and cortisol showed a similar pattern—eg, at blood glucose concentrations of 3·8 mmol/L [SD 0·4] vs 2·6 [0·3] for epinephrine.

Interpretation

Glucose thresholds for counter-regulatory hormone secretion are altered in well controlled type-2 diabetic patients, so that both symptoms and counter-regulatory hormone release can take place at normal glucose values. This effect might protect type-2 diabetic patients against episodes of profound hypoglycaemia and make the achievement of normoglycaemia more challenging in clinical practice."

What the above study shows is that, in people with "well controlled" T2DM (mean HbA1c 7·4%, SD 1·0 is poor control. Less than 6% is good control), there is counter-regulatory release of adrenaline, noradrenaline, growth hormone and cortisol at normal blood glucose levels. This is bad, as it's unhealthy to have release of counter-regulatory hormones under normal living conditions.

EDIT: Graham posted this study in support of his belief that there is low/no cortisol etc secretion due to blood glucose not falling low enough. This study actually counters his belief, as blood glucose doesn't fall low enough due to excessive cortisol etc secretion!

Broccoli Bread

I'm not quite convinced that bread should involve broccoli....but still this looks interesting and tasty.  I've made a few of Anna's recipes - her recipe book is fantastic - and I will make this I am sure.



Check out the whole post.

Music AND lights.

What else but...

Not only can I now tolerate loud music but also I can now tolerate bright lights. Misaligned car headlamps no longer annoy me like they used to.

Hillfit v 2.0

I've finally updated Hillfit - the ebook that I released about 16 months ago.  The idea behind Hillfit is that the average person who enjoys hiking, hillwalking and time in the outdoors can have more fun, find every walk easier, be safer and more resilient by getting a bit stronger.

Getting Stronger

Getting stronger shouldn't be a complex matter - picking some simple and safe exercises and doing them consistently can make a huge difference.

The focus of it all is enjoyment  -  I want you to have more fun in the hills - getting stronger lets you do that.

What is new

Version 2.0 is a lot more than an update.  It contains about 70 additional pages, more material and contributions from several other trainers and exercise scientists.  The structure is:

• PART 1 WHY GET STRONGER
• PART 2: HOW TO GET STRONGER
• PART 3: APPLYING YOUR STRENGTH TO THE SKILL OF WALKING
• PART 4: BEYOND STRENGTH
• PART 5: PUTTING IT ALL TOGETHER

Contributors

This time, it is not just me...there are contributions from 

• Tim Anderson - who writes about the mental and physical benefits of hiking in the countryside
• James Steele II - explains how there is no such thing as cardio - proper strength training has a range of metabolic, cardiovascular and cellular impacts that are normally only associated with endurance training
• Skyler Tanner - notes how walking  is different from exercise
• Bill DeSimone - describes how to choose safe exercises 
• Steven Sashen - looks at how to walk efficiently
• Todd Hargrove - outlines some exercises to improve mobility, balance and proprioception
• Colin Gordon - writes about  mobility and some daily exercises to keep you supple.

Buy it here

The book is for sale via www.hillfit.com  or you can just click here:

The price is now £10.

Questions

If you have any questions, please get in touch.

Can very-low-carb diets impair your mental faculties?

I wanna tell you a story...

In 2006, I had a test done on my pituitary gland*, called an Insulin Shock Test. It was pretty much what it said on the tin. I laid on a hospital bed, I was injected with an overdose of insulin and I was monitored for blood glucose and growth hormone levels every 30 minutes.

My blood glucose fell and fell and fell and fell until it reached ~1.5mmol/L (~27mg/dL). What happened was interesting. I came out in a cold sweat and developed a tremor. Apart from that, I felt fine. The consultant in charge was chatting to me and I was chatting to him. Eventually, I was given a sandwich, a yoghurt and a banana to eat.

Some time later, when I had stopped sweating and shaking, the consultant returned and told me that I had become confused. My brain had ceased to function correctly due to a lack of blood glucose (the insulin had totally suppressed serum FFAs and ketones, so there were no other brain fuels available), but I was too mentally-impaired to know that I was mentally-impaired. As far as I was concerned, everything was fine & dandy. This is the Dunning-Kruger effect.

Referring to Blood Glucose, Insulin & Diabetes, as blood glucose falls due to either starvation or a lack of dietary carbohydrate, insulin falls and glucagon rises, stimulating the liver to convert liver glycogen into glucose for export to the blood. Eventually, liver glycogen becomes depleted and blood glucose falls again. The pituitary gland notices this and secretes AdrenoCorticoTropic Hormone (ACTH) which stimulates the adrenal cortex to secrete cortisol. The adrenal glands are also stimulated to secrete adrenaline (a.k.a. epinephrine). Cortisol increases the conversion of amino acids and other substrates into glucose by the liver and kidneys. If blood glucose continues to fall, the pituitary gland secretes growth hormone (GH), which has an anti-insulin effect.

From http://anthonycolpo.com/boosting-growth-hormone-with-diet-training-fact-or-fiction-part-2/:-
"after the zero-carb phase, subjects reported symptoms of hypoglycemia that included weakness, irritability, mental confusion, nausea, hunger, cold sweating and disturbed co-ordination. GH levels were higher during exercise after the low-carb phase, but so too were levels of other fuel mobilizing hormones such as epinephrine, glucagon, and cortisol." Epinephrine, glucagon, and cortisol are stress hormones. Chronically-high blood levels of stress hormones disrupt sleep and cause irritable, aggressive behaviour.

Ethanol inhibits gluconeogenesis in the liver (possibly also in the kidneys) resulting in worse hypoglycaemia. Worse hypoglycaemia results in more ACTH & adrenaline secretion and worse hypercortisolaemia, which can adversely affect the hippocampus, impairing memory.

In conclusion, if you want to eat a very-low-carb diet, long-term:-1) Don't do much high-intensity exercise. See "Funny turns": What they aren't and what they might be.
2) Don't drink much (if any) booze.

See also Can Low-Carb Diets Make You Crazy?

*My pituitary gland failed the test by secreting only 40% the amount of GH that it was supposed to. For six months, I was given GH to inject using a special pen with a 8mm x 0.3mm needle. By the end of the six month trial, I had perfected the art of painless injection. The trial was discontinued due to lack of any noticeable benefit (17 days supply of GH @0.3mg/day cost £120!).

Full script of mum's funeral.

http://homepage.ntlworld.com/nigel.kinbrum/Laurel%20Carey%20-%20family%20script.htm

All blue underlined text are clickable links.

Type 2 diabetes in the UK.

From Insulin usage in type 2 diabetes mellitus patients in UK clinical practice: a retrospective cohort-based analysis using the THIN database:-

"Importantly, this analysis has been conducted using routine data from UK clinical practice, which allows an insight into how patients are managed in current UK practice. In summary, this study demonstrates a persisting delay both in oral therapy escalation and insulin initiations in patients with type 2 diabetes, with a relative reduction in the effectiveness of oral therapy escalation. There is an apparent threshold HbA1C of > 8.5% beyond which additional oral therapy in routine practice appears unlikely to achieve an HbA1C target ≤ 7.0%.
This study thus highlights the need for more timely escalation of glucose-lowering therapy, including insulin initiation, in order to limit unnecessary patient exposure to hyperglycaemia and associated serious consequences, such as macro-vascular and micro-vascular complications."

An HbA1C of 7.0% still results in macro-vascular and micro-vascular complications. If someone develops type 2 diabetes in the UK, the NHS isn't going to save them. They have to save themselves.

See also Having Diabetes and Car Insurance and Applying for a Driving Licence and Informing the DVLA. Basically, developing type 2 diabetes in the UK sucks.

People who have Impaired Glucose Tolerance need to take action to prevent their condition from deteriorating into full-blown Type 2 diabetes. See http://nigeepoo.blogspot.co.uk/search/label/Diabetes.

Low-glycaemic diet seen to reverse diastolic dysfunction of diabetes.

From http://www.medscape.com/viewarticle/802947?nlid=30763_1301&src=wnl_edit_dail (Medscape log-in required):-

"Of 32 overweight or obese diabetic patients (mean body-mass index, 34) without cardiac disease who were engaged in a "rehabilitation program in order to lose weight" that included two hours of supervised aerobic exercise per day, half followed a low-glycemic diet (25% carbohydrate, 45% fat, 30% protein) and the other half a low-fat diet (55% carbohydrate, 25% fat, and 20% protein) for three weeks. The diets provided the same amount of calories. Those on the low-fat diet then switched to the low-glycemic diet for an additional two weeks"

"....the two diets led to about the same declines in weight and waist circumference..."

The diet was 25% carbohydrate, 45% fat, 30% protein.
It was a low-carbohydrate/low-glycaemic load diet.
It was not a very-low-carb diet.

An interesting side-effect of stress reduction.

While mum was ill, I was under constant stress. This went on for five years and nine months. I'm no longer stressed. I have some paperwork to sort out, but I'm no longer dreading hearing the phone ring.

Last night, at the jam session in the Unicorn Pub, I noticed something interesting. I was sitting in front of the loudspeakers, but the loud music wasn't hurting my ears. Normally, I have to use Alpine Music Pro ear defenders. Last night, I didn't need them!

I'm wondering whether I had elevated cortisol all those years. The NHS only tests morning (9am) cortisol.

Here's another photo from the 15th April jam session.

The Human Effect Matrix

The guys behind Examine.com have just released a great new resource:  a "Human Effect Matrix."

For every supplement in their database, a handy table tells you what effect each supplement has and how noticeable that effect is.

To see what we are talking about, click through to see what the scientific studies say about:

Beta-alanine  or   Whey Protein  

Weird filters, Part 2.

Here's that weird picture again.

Why is it that some people see the world through weird cognitive bias filters? It makes discussion with them impossible, as what I write is remixed with weird filters into something completely different. They then argue against something completely different, not what I wrote. This is the classic Straw Man argument.

Here are some more examples of remixing with weird filters:-

"I can eat whatever I want" is remixed into "I can eat as much as I want". I actually meant "there are no banned foods".

"Inject some insulin" is remixed into "Shoot-up insulin to cover the 400g of carbs that I never even mentioned!"

To all intents & purposes, I had T2DM. Another 0.2mmol/L on my fasting serum glucose and I would have been diagnosed as having T2DM. As my fasting serum glucose was slowly increasing, it would have soon gone over 7.0mmol/L, had I not got lucky and fixed the underlying problem.

In January 2003, I had impaired Glucose Tolerance (fasting serum glucose = 6.8mmol/L on one OGTT, and 2 hours post-75g glucose load serum glucose = 8.7mmol/L on another OGTT). A sandwich used to send me to sleep.

By September 2008, I had normal Glucose Tolerance (fasting serum glucose = 5.0mmol/L & 2 hours post-75g glucose load serum glucose = 3.7mmol/L on the same OGTT). I also no longer suffered from hyperinsulinaemic drowsiness. I was approximately the same weight that I was in 2003, so the improvement was not due to weight loss.

P.S. Information about ways to tackle Insulin Resistance can be found in Insulin Resistance: Solutions to problems.

N.B. If someone has a valid medical reason for being on a very-low-carb or ketogenic diet, that's fine by me. I don't think that it's necessary for people with T2DM to be on a very-low-carb or ketogenic diet. In fact, eating more carbohydrate allowed Jason Sandeman to reduce his insulin dose for good BG control.

You are *never* going to guess what happened on Saturday night.

I attended a gig at The Falkners Arms by a band called Mirrorball.

During the gig, a young lady asked the band if she could get up on stage and sing a song with them, to which they agreed. While the young lady was singing "Valerie" by Amy Winehouse, the lead singer stood by the table where I was sitting and put his glass on it. After a while, when he turned to pick up his glass, I attracted his attention and asked him "Can I have a go?" He asked me what I wanted to sing and I replied ""Sit down", by James".

He said that "Sit down" wasn't in their set-list, to which I replied "It's 8 beats in E, four in A and four in B. Rinse and repeat". He said that he'd ask the other band members during the break. Some time later, during the break, he returned and said that some of the band knew the song, so I would be up immediately after the break.

I was, too! I'm still buzzing! See also http://www.lemonrock.com/mirrorball?page=applause

Here's me at the Unicorn jam session on 15th April, doing backing vocals on "Mustang Sally".

Dr. Richard K Bernstein on insulin for type 2 diabetics, and some definitions.

Dr. Richard K Bernstein:-

Dr. Richard Bernstein, the world's leading low-carb diabetologist, says in Diabetes: The Basics:-
"Many people (including the parents of diabetic children) view having to use insulin as a last straw, a final admission that they are (or their child is) a diabetic and seriously ill. Therefore they will try anything else - including things that will burn out their remaining beta cells - before using insulin. Many people in our culture have the notion that you cannot be well if you are using medication. This is nonsense, but some patients are so convinced that they must do things the “natural” way that I practically have to beg them to use insulin, which is as “natural” as one can go. In reality, nothing could be more natural. Diabetics who still have beta cell function left may well be carrying their own cure around with them - provided they don’t burn it out with high blood sugars and the refusal to use insulin."

Some definitions:-

From Low-carbohydrate diet:-
"The term "low-carbohydrate diet" is generally applied to diets that restrict carbohydrates to less than 20% of caloric intake, but can also refer to diets that simply restrict or limit carbohydrates."
A typical woman consumes ~2000kcals/day. A typical man consumes ~2,500kcals/day. Therefore...

Very-low-carb diet = <10% energy from carbs ≡ <~50 or ~62.5g carbs/day.
Low-carb diet = <20% energy from carbs ≡ <~100 or ~125g carbs/day.
"Healthy eating" = >55% energy from carbs ≡ >~275 or ~344g carbs/day.

The unusual suspects.

In The usual suspects., I banged on about deficiencies in Vitamin D3, long-chain omega-3 fatty acids (EPA & DHA) and Magnesium.

It's the one on the right. Our right, not their right.

According to Jane Karlsson, the iron-manganese ratio and the zinc-copper ratio are also very important. Very-low-carb diets can in theory cause iron overload (if lots of red meat is eaten) and deficiencies in manganese and copper. This may be why people on such diets often find that their glucose tolerance doesn't improve.

Dietary copper and risk of coronary heart disease.
Meat diets and fragile bones: inferences about osteoporosis.
PubMed search for Klevay LM[Author]

For the top 999 foods highest in Manganese per 100g serving, see HERE.

For the top 468 foods highest in Copper per 100g serving, see HERE.

Of roads and rulers.

In the UK, unadopted roads can be well-maintained, or look like this...

Residents of Tennyson Avenue, Thorne, have been battling for years to have their unadopted road repaired. They have now been told that they need to pay £5,300 each for the road to be resurfaced. Pictured back l-r are Russ Clarke, Sue Taylor, Anne Kershaw, and her husband George. Front l-r are Lyn Shadlock, and Paul Willerton. Picture: Liz Mockler D2524LM

The following scenario is made-up. All characters are fictitious and any similarity to anyone living or dead is purely coincidental.

Nigel/Nigella lives on an unadopted road and got fed up riding his/her bicycle on the road as it was full of pot-holes. He/she called a residents meeting and made the following proposal:-

I will organise the repair of our road. I will phone some road repair companies and get them to quote for the repair of our road. I will call another residents meeting to tell you the pros and cons of each company and their quotes. We will then vote to decide which company gets the job. We will all contribute an equal amount to cover the cost of the repair plus a reasonable allowance for me, to cover my time spent.

Two outcomes come to mind.

1) Nigel/Nigella is a charismatic "people-person". All of the residents agree that Nigel/Nigella can organise the repair of the road and on his/her allowance. They later vote for a repairer and pay Nigel/Nigella the monies required. Nigel/Nigella gets the company to repair the road. Everyone is deliriously happy. Nigel/Nigella becomes head of the residents association. Nigel/Nigella becomes Mayor. Nigel/Nigella becomes MP. Nigel/Nigella becomes Prime Minister.

2) Nigel/Nigella is a nerd with poor social skills. One or more of the residents refuses to pay for repair of the road as they drive "Chelsea Tractors" (4x4s) and potholes are not a problem for them. The project is cancelled. Nigel/Nigella vows to not bother trying to make life better for people in future. The road remains full of pot-holes, like the one in the picture above.

The above scenario applies to residential roads. Who maintains non-residential roads? If no-one is in charge, all non-residential roads would need toll-barriers at entrances and exits, to collect monies for their maintenance. Alternatively, everyone pays road/council tax to some authority to cover the cost of road maintenance plus other essential services plus cost of organisation and lets the authority get on with it. "Top-down" authority has its advantages. We pay someone else to sweat the petty stuff.

Many years ago, life was simple. Things got done by individuals and groups of individuals. Nowadays, life is extremely complicated. To make things run relatively smoothly, we have laws, rules & regulations. Some laws, rules & regulations are good and some are stupid. The only way to get rid of the stupid ones is to vote for the person who pledges to abolish the largest number of stupid ones (and introduce the smallest number of new stupid ones) and hope that that person sticks to their pledges if they are elected.

Be afraid. Be very afraid.

Be thankful that we Brits aren't allowed to bear arms, as this would totally happen if we were...

There, their, they're! I think that that's enough silliness for one day.

Expectations, Surprises and Internet eejits.

Expectations:

Pussy Galore.

In mid-July 2007, I noticed that mum was slightly confused. By the beginning of August 2007, mum had become noticeably confused (she locked herself out of her bungalow and two days later, didn't recognise her own living room). I did some research on the internet. As mum already had Parkinson's Disease for a few years, the most likely diagnosis for her increasing confusion was Dementia with Lewy Bodies (DLB). According to the DLB site, the mean survival time was six years from the first onset of symptoms. So, for the last five years and nine months, I've known roughly what was going to happen, how it was going to happen and how & when it was going to end. Sometimes, ignorance is bliss.

Surprises:

Life can be stranger than fiction. When mum divorced dad forty-five years ago, mum got the house as my sister & I were living there and she got child maintenance payments from dad. As a result, dad had nothing to do with mum & me from that day onwards. He still maintained contact with my sister.

Yesterday, while sitting in a solicitor's office, my mobile phone rang. It was my sister. She had tried to phone dad on Monday to inform him of mum's death, but he wasn't answering the phone. She phoned one of dad's family to get them to check on him. He had a fatal heart attack on the same day that mum died. Spooky!

Internet eejits:

1) I received the following email at 04:08 today:-
"Dear Nigeepoo,

Your account on BodyRecomposition Support Forums has been locked because someone has tried to log into the account with the wrong password more than 5 times. You will be able to attempt to log in again in another 15 minutes.

The person trying to log into your account had the following IP address: 96.47.226.20

Don't forget that the password is case sensitive. Forgotten your password? Use the link below:
http://forums.lylemcdonald.com//login.php?do=lostpw

All the best,
BodyRecomposition Support Forums"
You'll never guess my password.

2) Read THIS (everything turned out O.K. in the end!)

3) Read THIS (warning, very strong language!).

I show no mercy to internet eejits. You have been warned!

EDIT: Alan Aragon fully supports Evelyn Kocur (CarbSane). Therefore, anyone who attacks Evelyn must also attack Alan, otherwise they are a hypocrite. Good luck with that!

PULLING SOME THREADS TOGETHER: SITTING, POSTURE AND GRAVITY

I CALL ON YOU TO FIGHT GRAVITY

This might be a bit of a disjointed post but I wanted to pull together a few ideas that I’ve been thinking about recently, prompted by a few things that I’ve read some of which I’ve mentioned here.    It is just a case of getting some ideas out of my head, so please do not be too hard on me for a long rambling post.

Over the life of this blog I have looked a few times at posture and neuroplasticity – the idea of how the brain itself can change and modify itself in response to what you do with it and with your body.  I’ve also often pointed to the reports of the dangers of a sedentary life.  Without necessarily spinning some grand theory I wanted to highlight a few ideas and maybe begin to plot some connections.

MUSCLES THAT TIGHTEN, MUSCLES THAT GET LOOSE

This is an idea that I think I first came across from Mark Reifkind, then Paul Check and then Dan John.  I think Chek got it from Janda.  They talk of tonic and phasic muscles.   Certain muscles tend to get tighter with age, injury, under-use or over-use.  These need to be stretched.  Others tend to get weaker and they need to be strengthened.

Which ones are which?

MUSCLES THAT   GET   TIGHTER WITH AGE Stretch them	MUSCLES THAT GET WEAKER WITH      AGE Strengthen them
Upper Trapezius Pectoralis Major (Chest) Biceps Pectoralis Minor (deep chest muscle) Psoas (hip flexors) Piriformis Hamstrings Calf Muscles	Rhomboids Mid-­‐back Triceps Gluteus Maximus Deep Abs External Obliques Deltoids

A simple way to picture all this is of flexors and extensors.  The flexors – the muscles that bend, that pull bones together – get tighter.  All of those muscles in the left hand column: when they get tight, flexed, you end up in a tight ball.  Legs bent, toes pointed, knees to chest, arms bent, shoulders hunched up and chest collapsed.  You go foetal.  The extensors are the opposite.  These are the muscles take you from the foetal to the upright.  When these are tight you are erect, arms and legs straight, shoulders back.

When we think of an old person, we picture then with the flexors tight – they are bent over, stooped, arms and legs bent.  The youthful person is different – they are erect, the extensors are working well. 

We have a battle between flexion and extension.  Between the foetal position, which becomes the posture of old age, and the erect posture of the child and the athlete.

Incidentally, notice also how the foetal position is the position we adopt in fear, in response to a threat.  The brave, resistant fearless position is the opposite.

It is also interesting that the muscles we need to strengthen are often those that we ignore or find boring.  We need to be rowing, pressing, hingeing and squatting rather than curling and bench pressing.

GRAVITY AND THE BATTLE

What makes this battle?  Gravity. 

This is where I come back to the ideas of Philip Beech and his erectorise exercises.  It is also connected to the writings of Dr. Joan Vernikos, who notes that sitting and the sedentary life is actually a life in which people minimise the effect of gravity.  She compares the impact of weightlessness on astronauts and each of the negative health impacts that are observed in them are evident to a lesser scale in those who spend a lot of time seated.

We tend to forget about gravity.  It is always there!  Forget about exercises, liftin weights or even lifting your bodyweight.  Our bodies are under a constant pressure from gravity.  Gravity is always trying to bend us over, push us down and return us to the foetal position from which we started.  It never stops.  To stand up, erect with legs straight, shoulders back and head up requires work, effort against gravity.  It requires the extensors to work……all the time.  Unless you keep working these muscles  BY SIMPLY STANDING AND BEING ERECT they will get weaker, they will get looser.  Gravity wins! 

The other muscles?  As you stop fighting gravity and you collapse – ultimately into a ball….or a chair – those flexors settle at a shorter length.  If you never stand up straight into extension, your hip flexors will never be lengthened.  Your hips will always be bent.  You will collapse in on your self.  You become old, flexed. Weak.

WE ARE IN A FIGHT WITH GRAVITY

As a child develops from back, to roll, to crawl, to sit, to stand, to walk, gravity is slowly battled and mastered.  The force that held the baby down is finally overcome until he is able to stand, the muscles keeping the body erect.  

We become what we were meant to be – a biped.  Upright and erect in command of our bodies.  And as such with healthy brains, plastic brains that develop the connections and the maps to govern that movement.  As we stand and move all of us gets healthy, even our brains.

But as we abandon the physicality of life, sit down and succumb to gravity that is lost.  All sorts of systems in the body suffer including the brain.

RECOGNISE THE FIGHT

We live in a world of gravity, but we don’t notice it.  Apart from all exercise and training, concerns about exercise form or protocol, first of all respect the basic truth that we live in a world of gravity.  This force is trying to pull you down – literally and metaphorically.  Health and simply being human depends on mastering gravity.  Stand up for yourself!  Stand against the world.  Think of all the phrases that signify strength and robustness – the things that you stand for, the things that you stand against.  Sitting down, sitting it out – you collapse, gravity wins.  Standing up – you assert yourself.

I don’t know where I’ve got with all this!

For more on these ideas, check out Geoff Neupert’s recent posts, or Dan John’s Lifetime Warrior Workout,or Paul Chek on the tonic /phasic concept.  Read stuff by Todd Hargrove and Tim Anderson

TAKE A STAND

Anyway if nothing else….start to think of standing as an heroic battle against gravity.  Keep up the fight as long and as effectively as you can.  Sitting, slouching, poor posture is giving up that fight.  Going foetal reeks of fear.  Getting erect speaks of character, fight and bravery.  (I've also noted on the blog before how posture affects attitude - if you want to be confident then take a confident posture)

Andrew Marr's stroke - HIIT?

I just thought I'd point to this - Is exercise to blame for Andrew Marr's stroke?  

Marr is a fairly high profile journalist / TV presenter in the UK.  He suffered a stroke a few months ago that he is now blaming on interval training on the Concept 2.

Marr said he had followed the advice to "take very intensive exercise in short bursts – and that's the way to health … I went on a rowing machine and gave it everything I had, and had a strange feeling afterwards – a blinding headache, and flashes of light – served out the family meal, went to bed, [then] woke up the next morning lying on the floor unable to move". 

As usual, the NHS piece is pretty balanced, although it is a little concerning the way in which the medics talk about the potential dangers of interval training:

"Regular exercise is an important factor in stroke prevention and recovery. We have heard anecdotally that some activities like vigorous exercise can sometimes cause blood vessels to burst. We need more research on the underlying factors that might make that happen.
"We do know that high blood pressure itself is the single biggest cause of stroke. Until more research is done on specific triggers, we'd suggest getting your blood pressure checked and taking steps to keep it under control – exercise can help with that."

Maybe there was more to it though:

Despite the media emphasis on the stroke risk exercise could pose, it should also be borne in mind that Andrew Marr has said that he had been "heavily overworked". Stress is a known risk factor for high blood pressure, and it is possible that this may have played a part in his condition.

Quality >> Quantity.

Mum passed away peacefully in the middle of the night. I'm waiting for paperwork to be done.

"And the best you can hope for is to die in your sleep."

On the internet, I read that Dementia with Lewy bodies has a mean survival time of 6 years from the onset of symptoms. Mum first became confused in mid-July 2007, so it's been just under 6 years. Does this mean that all of the supplements I gave her were worthless. Hell, no!

As mentioned in Look after your brain., mum's MMSE score increased from 14 to 26 out of 30 after taking medication and supplements. The medication gave a 3 point increase in MMSE score on average, so the rest of the increase in MMSE score was probably due to the supplements, which had no undesirable side-effects.

On Christmas day 2008, mum was capable of preparing Brussels sprouts for cooking, though she got the knives, forks & spoons mixed up when she tried to lay the table. Here's her final Christmas at home. Roast duck with all of the trimmings. Om, nom, nom!

Mum's last Christmas at home.

In conclusion, I believe that quality of life trumps quantity of life, so supplementation for the win.

....Feeling like a Heretic

Just an excuse to play some Lloyd Cole:


"Looking like a born again, living like a heretic"

That was the phrase going through my head this weekend as I thought about this post.  The heresy?  For so long I've been identified with, and I suppose in some ways promoted, certain positions in terms of fitness and diet.  There has been a lot of other stuff on the blog: big jumps, neuroplasticity etc, but the recurrent themes are probably diet and exercise.  Diet: paleo-ish and fairly low carb.  Fitness:  HIT style weight training.  The thing is, over the last few months, maybe longer, I've moved away from both to some extent.

Such shifts make me feel like a heretic....like I am rejecting some fundamental truths.  Not only a set of principles, but the people, the tribe.

Looking like a born again

 The change has not harmed me.  I am leaner than I used to be when limiting carbs and have more muscle than I did while training once a week to failure.

Giving up the search for the philosophers stone


There is probably more to write about why I've moved on from low carb paleo, but essentially I drifted from low carb - I realised that carbs were not the enemy but often the preferred source of fuel.  Then overtime I started to question much of the dogma of paleo, particularly the quasi-religious nature of the whole paradigm, this utopia from which we fell in which we all lived these ideal lives, with optimal diets, social interaction and physical activity.

In terms of exercise I am still walking, spending time in the hills.  I am doing balance work and trying the movement rests that Tim Anderson writes about in Becoming Bulletproof and Original Strength (very Feldenkrais influenced).  But weights has gone on to 3 or 4 days a week, with the old bodybuilding split of chest/shoulders/triceps & legs/back/biceps.  Focus on progression in weight, not going to failure.  One exercise "heavy" 3 sets of 4-8, then one exercise at 2 x12-15.  This is based on Brad Schoenfeld's paper on the mechanisms of hypertrophy (mechanical stress, metabolic stress and muscle damage) with the heavy move pushing the mechanical stress and the lighter set going for the metabolic stress.  A bit like Lyle's bulking routine.  I am not rejecting HIT, just talking a change for a while because I actually enjoy training more than once a week.

Gnosticism

The whole alternative, gnostic, hidden knowledge is so attractive.  We have something that the mainstream doesn't have.  It plays on the same fears and conceit that drives nutty conspiracy theories.

The thing is that all this alternative stuff is not really needed.  The mainstream often has the truth, but we do not want to listen or apply it.

The bodybuilders got it right

Increasingly I am coming back to positions that I had 15 or 20 years ago.  Maybe longer.  The sciencey bodybuilders.  Clarence Bass, Alan Aragon, Lyle McDonald.  Newer writers too like Go Kaleo.

We are searching for the truth about how to get lean, muscular and fit and the natural bodybuilders have been doing it for years. (Natural I said....drug assistance means lots more latitude).  Then build muscle and get lean....often without the craziness. (There is some craziness but there is also some sensible stuff)



The internet led me astray?

I discovered the internet in about 1996 and immediately started searching for fitness stuff.  I found low carb then paleo then Art Devany.....and then it was deep into the alternative realms.

The basics stay the same

I still think the basics are the same as I've been writing for a while:

Eat real food
Progressive strength training
Stand up straight
Get enough sleep.

and of course, patience and consistency.

I can't give up

I will keep reading, writing, thinking and hopefully progressing.... of course I can't give up the search to  improve, to learn.

Politics, Religion and Diet.

Three subjects that people love to fight about, as they are about beliefs ;-)

Human population vs Year.

 

Politics:

In Palaeolithic times, there weren't many people living on this planet. People hunted and gathered their food, and had relatively non-hierarchical, egalitarian social structures. According to archaeologists, violence in hunter-gatherer societies was ubiquitous. Approximately 25% to 30% of adult male deaths in these societies were due to homicide, compared to an upper estimate of 3% of all deaths in the 20th century. The cause of this is near constant tribal warfare: "From the !Kung in the Kalahari to the Inuit in the Arctic and the aborigines in Australia, two-thirds of modern hunter-gatherers are in a state of almost constant tribal warfare, and nearly 90% go to war at least once a year." However, due to the extremely low population back then, extremely few people were killed in absolute terms. Then, around 10,000 BC, some bright spark/bulb invented agriculture...

Fast-forward a few thousand years to the time of Genghis Khan. He came to power by uniting many of the nomadic tribes of north-east Asia. The Mongol invasions resulted in wholesale massacres of civilian populations. His descendants went on to stretch the Mongol Empire across most of Eurasia by conquering or creating vassal states out of all of modern-day China, Korea, the Caucasus, Central Asian countries, and substantial portions of modern Eastern Europe, Russia and the Middle East. Many of these invasions repeated the earlier large-scale slaughters of local populations. However, due to the low population (around 300 million), few people were killed in absolute terms. Then, around 1,600 AD, some bright spark/bulb invented government...

As mentioned in How did we get to where we are today? Part 2., the invention of liberal government encouraged the exchange of ideas and entrepreneurship. Monarchies taxed people, but their bureaucracies stifled entrepreneurship, so the French and the Chinese invented loads of stuff that never saw the light of day. We Brits got lucky. As a result, the Industrial Revolution created wealth out of dirt, which led to rapid economic growth and rapid population growth. The Green Revolution led to more rapid population growth.

Fast-forward to the 21st Century. Warfare has killed millions of people. Rulers have killed hundreds of millions of people (the vast majority by totalitarian & authoritarian regimes), according to Anarchy Begins at Home: The Blog Series Part 6 – Democide. However, due to the extremely high population, only approximately 5.6% of the total population have been killed by rulers. That's what I call relative peace.

EDIT: I don't want a system where entire populations can be slaughtered by armies led by a charismatic leader. I also don't want a system where the poor & underprivileged are "free" to die in poverty. Some people scrounge off Social Security, but the amount of money scrounged by them pales into insignificance compared to the amount of money scrounged off the rest of us by the wealthiest people on this planet.

 

Religion:

I'm not religious. I have no problem with people believing in God, as long as they have no problem with me not believing in God. A thought experiment that you may find interesting is God's Debris, by Scott Adams.

 

Diet:

Read the rest of my blog, dammit!

In other news...
Mum is now in a coma, but her breathing is regular.

No such thing as Cardio

James has contributed a chapter to the new version of Hillfit, which should be out in a couple of weeks,  in which he covers the things he goes through in this talk.

Failure to communicate, civil wars and dim bulbs.

Hat-tip to marie (who's a very bright bulb indeed!) for the following video.


Whaz so civil 'bout war anyway?

The reason why I'm writing this is because there's (un)civil war on the internets between various "camps".

At any given moment:-
There are people who function physically & mentally at their best on VLC/Keto diets.
There are people who function physically & mentally at their best on LC diets.
There are people who function physically & mentally at their best on MC diets.
There are people who function physically & mentally at their best on HC diets.
There are people who function physically & mentally at their best on VHC diets.
As people's circumstances change, they move to a different category.

If you don't understand what I wrote above, you are a dim bulb.
If you think that insults can offend me, you are a dim bulb.
If you think that agreeing 90% with someone makes me an ass/arse-kisser, you are a dim bulb.
If you think that I'll take insults from you without retaliation, you are a dim bulb.
Sadly, due to the Dunning–Kruger effect, dim bulbs are too dim to know that they are dim bulbs!
If you are offended by anything that I wrote above, I don't care.

In other news...
Mum's condition has deteriorated to the point where she is unresponsive and no longer has a swallow reflex. It's just a matter of time before she dies. I've been prepared for this for quite some time.