diabetes

A ketogenic diet as a preventative and treatment for malaria

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It is not as if diabetics don’t have it hard enough.  They already have increased risk of cancer, kidney disease, cardiovascular disease, and Alzheimers?  But it is now becoming clear that one of the deadliest diseases on the planet, malaria, also attacks diabetics with great efficiency.  Thus, a study in Ghana has linked diabetes and increased malaria.  Malaria kills about one million people every year.  Could it be that a high-carbohydrate diet that leads to uncontrolled blood sugars also makes one susceptible to malaria?

Malaria is caused by a parasite that inhabits red blood cells (erythrocytes).  The infected cells  have an enormous requirement for glucose (emphasis mine):

Malaria parasites also are dependent on glucose as a nutrient source. As Plasmodium has no capacity to store energy in the form of glycogen they rely entirely on an exogenous supply of glucose. The infected erythrocyte exhibits a substantial increase in its permeability to low molecular weight sugar. The metabolism of the parasite utilizes up to 75 times more glucose than uninfected erythrocytes. Glucose is vital for Plasmodium. An in vitro study (H Humeida et al., J of Diabetology, October 2011, 3:6) has shown that growth and proliferation is impaired below 5.5 mM.

I wonder if a person had constantly normal blood sugars (4.3-4.6 according to Richard K. Bernstein), which can only be achieved through fasting or ketosis, whether this would ward off malaria.  Apparently so.  Malaria apparently recurs in famine victims as a result of refeeding (Anuraj Shankar, “Malaria and Nutrition”, 229f. in Nutrition and Health in Developing Countries, Richard D. Semba, Martin W. Bloem eds.):

studies in famine relief

studies in famine relief 2

Thus, the moment that the starvation victim receives anew a high carb diet, the malaria parasite seizes the opportunity to multiple.  Apparently, the ketogenic state of starvation makes it difficult for the parasite to obtain adequate glucose.  It stands to reason that the uncontrolled blood glucose is the the reason that diabetics are at greater risk of malaria.  My guess is that a low-carb high-fat diet would greatly reduce the risk of malaria.  In addition, perhaps fasting followed by a ketogenic diet should be recommended along with anti-malarial medications as a treatment.  If a person can afford no other treatment, perhaps fasting could potentially act as a cheap cure.

So carbs are poison not only because of the damage that high blood sugars cause to bodily tissues but because of the parasites that the high carbohydrate diet promotes.  This includes Candida (yeast infections), parasitic worms and Lyme disease.  And now we can add malaria.

Which one of these two guys should take statins? Or, Is high LDL really a danger for those on a low-carb high-fat diet?

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When I realized that I had multiple symptoms of diabetes, I started to follow Richard K. Bernstein’s Diabetes Solution and have attempted to control my blood sugar through an ultra-low carbohydrate, high fat diet.  I eat two eggs scrambled in two tablespoons of saturated fat, steak or bacon and sausage for breakfast, Korean soup with meat, kim chee and eggs for lunch, an avocado mixed with other salad and meat for supper, often with another low-carb vegetable.  For snacks I’ll have sugar-free cheese cake or sugar-free crust-less pumpkin pie, topped with copious amounts of whip cream and a few berries (~tablespoon) or a few nuts, boiled eggs with mayonnaise and salt, pepperoni, or other sausage.  I avoid all sugars, all grains (including rice) and all vegetables high in carbs (no potatoes, carrots or legumes).  I suppose my total carb count is between 30 and 50 gm per day and I assume that I am in a consistent state of ketosis.

My low carb high fat diet has begun to heal me.  I experience much less peripheral neuropathy, my arthritis has largely disappeared, my diabetic dermopathy is gone, and I have lost a lot of weight.  Here are the before and after pictures.

OLYMPUS DIGITAL CAMERA

Before December 2012

slimmer me

Today, after ten months of high fat low carb diet

Yet my doctor wanted to put me on statins because my cholesterol is very high, in her view, and needs to be brought down because I am at 10% risk of having a heart attack in the next ten years.

So here are the before and after numbers of my blood test: first number is ten months ago (American conversion in parentheses), and the second number (after the slash) my most recent test (two weeks ago):

  1. Total Cholesterol: 6.3 (243) / 9.21 (356)
  2. HDL Cholesterol:  1.0 (39) / 1.3 (50)
  3. Triglycerides: 2.34 (207) / 1.37 (121)
  4. LDL (calculated): 4.24 (164) / 7.29 (282)
  5. HBA1C: 6% / 5.5%

Here are some other markers not on the blood tests:

  1. Weight in pounds: 260 / 210
  2. Waist measurement in inches:  44″ / 36.5″
  3. Average blood sugar during previous three months (calculated from hbA1C):  7.7  (136) / 6.6 (118)
  4. Snoring has lessened both in frequency and decibels.
  5. No significant loss of lean mass.
  6. Blood pressure is now in the optimal range instead of borderline hypertension (without drugs).

My diet is healing me without the help of drugs.  The only marker that has worsened, at least in the eyes of the medical community, is LDL. Yet now my physician wants to put me on statins.  However, I refuse to go on statins, especially now that I’ve done a bit of research.  As for the blood work, the triglycerides are down 40% and the HDL is up 30%.  My HBA1C has improved, but it is still too high in my opinion, and this is likely because my liver over produces glucose (gluconeogensis), especially in the morning (dawn phenomenon), and so my metabolic disorder continues despite my strict diet.  Yet my family doctor is ill-equipped to help me with this particular marker, a true sign of metabolic syndrome and diabetes, and is only concerned to lower my LDL.  Having done a week’s worth of reading, several important facts have become clear to me:

  1. Elevated LDL is a marker only–it is not a disease.
  2. High Cholesterol or high LDL have no correlation with artery disease.
  3. High Cholesterol or high LDL are not proven causes of artery disease.
  4. The link between metabolic syndrome/diabetes and heart disease is far clearer and more convincing than any alleged link between cholesterol and heart disease.
  5. No one can answer the question of whether a person that has adopted a low carbohydrate lifestyle but has high LDL is really at risk.  No such long term study has ever been done.
  6. A person with low triglycerides but high LDL is more likely to fall into the “Pattern A”  than the “Pattern B” cholesterol.  My alleged VLDL (very low density lipids) has dropped from 41.4 to 24.2, suggesting that I am shifting from Pattern B to Pattern A.

Is my doctor not guilty of straining a gnat and swallowing a camel?  She had little concern about the true risk factors for heart disease (camel):  high HBA1C, low HDL, high triglycerides, and visceral obesity (fat around the waist); but she was ready to kill the gnat, high LDL.  While she had the results of my earlier test, she manifested not the slightest approval in my improved numbers and was anxious only about my higher LDL; and she was more worried about me than the physician who went through the numbers with me ten months earlier.  The medical profession seems to have disordered priorities.  This is clear from a look at heart risk calculator that she used. Risks factored into the equation are as follows:

  1. Age
  2. Male or female
  3. Low HDL-C
  4. Total Cholesterol
  5. Systolic blood pressure
  6. Diabetes
  7. Smoker

According to her risk assessment, I have a 18.4% chance of cardiovascular disease in the next ten years.  Using the same assessment criteria, my earlier self (see “before” picture)  had a 15.6% risk.  My loss of 50 lbs around my fat belly counts for nothing; my lower triglycerides and lower HBA1C (because I’m not “diabetic”) count for nothing.  Yet which guy in the above pictures do you think has the more likely chance of a heart attack?

Now I am mostly happy with the results of the latest tests and I am very happy with the improved state of my health.  Here are my three options going forward:

  1. Take statins to reduce my LDL.
  2. Reduce my consumption of saturated fat to reduce the LDL.  Why?  My current diet is healing me.
  3. Continue as before trying to fine tune my blood sugar issues and shoot for an HBA1C of 5.0%, Triglycerides of 100, and HDL of above 60.  Reject my doctor’s anxiety about LDL, her dietery advice and her recommendation of statins.

I found the blog of Dr. Rakesh Patel in Arizona who himself decided to low carb using the Carbnite Solution (CNS) and was feeling much better after four months, but his LDL-P had skyrocketed.  What to do?  He decided to actually test himself for artery disease, because he believed that metabolic syndrome, not high cholesterol, was its likely cause.  He therefore did not want to treat something that is not a disease.  He himself had a Carotid Intima Media Thickness (CIMT) scan before the low carb diet and then at the four month mark his improvement was remarkable.

I had my CIMT done in 2006 on the Standard American “heart healthy diet” eating low fat, higher carb. You know those espoused by the ADA and AHA. My lipids were “normal” at this time. My thickness was 0.6 mm (about the 50th percentile). I also had two small “road bumps “ (minimal plaques) at my left carotid bulb both measuring 1.2 mm. I was not happy. I also had similar findings on a study in 1/2010.

Flash-forward to June 2012, about 4 months into CNS, my CIMT showed a thickness of 0.445 mm (13th percentile) and I had the vascular age of a 16 year old! And oh by the way, the “road bumps” were gone. All the while carrying an LDL-P of over 2500 consistently for over a year. I have also had a CT Coronary Calcium score that was zero.

Some primitive people who eat a diet rich in saturated fats and low in carbs never experienced problems with heart disease (like the Masai).  Saturated fat, and the resulting high LDL that occurs in some people like myself and Dr. Patel, does not seem to cause heart disease.  A diet rich in carbohydrates marked by high triglycerides, low HDL and high HBA1C causes metabolic syndrome, obesity, inflammation and artery disease.  This is why diabetics have a much higher risk of death by heart attack.  My maternal grandmother was diabetic and died of a third heart attack.  Yet stubbornly, most doctors will not recommend high fat low carb diet because they’ve been taught to fear fat and cholesterol.

Now to answer the first question posed in the title:  Which one of these guys should take statins? The guy in the before picture or the guy ten months later?  In my opinion, neither.  The guy in the first picture was eating too many carbs and needed to stop it.  The guy in the second picture has rapidly improving health already.  Why would you want to possibly destroy that with a potentially harmful treatment of a non-disease?

Offline Resources consulted:

Anthony Colpo, The Great Cholesterol Con, 2012
Jeff S. Volek, Stephen D. Phinney, The Art and Science of Low Carbohydrate Living, 2011.
Gary Taubes, Good Calories, Bad Calories: Fats, Carbs, and the Controversial Science of Diet and Health, 2007, 2008.
Richard K. Bernstein, The Diabetes Solution, 2011.

Peter Attia at TEDMED: Is the “obesity crisis” just a disguise for a deeper problem?

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Dr. Peter Attia blogged about his experience at TEDMED in April, and I’ve noticed that his lecture is finally available. It is very moving. He recounts how he treated a diabetes patient in emergency with contempt because she was fat. At the time, he was self-assured about what causes obesity and diabetes, and yet, he thought, this woman let herself get into the position where she needed an emergency foot amputation to save her life. Later, he learned that obesity is probably not the disease but a symptom of metabolic syndrome, a problem which he himself now had even though he was exercising several hours a day.  The system (meaning the standard health advice as it relates to dietary matters) had let this woman down, and he asks her forgiveness for his lack of compassion and kindness towards her.

Dr. Attia admits that the medical profession is in need of humility, because if his new understanding of the role of metabolic disorder is correct, the medical profession has been giving the wrong advice to their patients for many decades.  He now suggests that obesity is a symptom not a cause of metabolic syndrome and blaming the victim of the disease is neither compassionate nor a helpful solution to the problem.

Personally, I know that I was able to shed 50 lbs of fat by eating red meat, eggs and by increasing my dietary fat, but above all, by lowering my carbohydrate intake to about 30 gm per day.  This was against the advice of a physician who said to eat less red meat, exercise, blah blah blah.  Had I followed the standard dietary advice, I’d still be suffering from my metabolic issues.  Congratulations Dr. Attia, on a helpful lecture which will hopefully stir people, especially other doctors, to do the right thing.

Exercise to lose weight to avoid or treat diabetes? Give me a break

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A few years ago, a missionary friend of mine visited us here in Ontario.  He was keen to go fishing, and so one early afternoon, we rented a canoe at Lake Opeongo and headed towards North Opeongo beyond which was located our campsite.  But the winds were against us and soon they had driven us to the far shore of East Opeongo; and so we had no choice but to make camp there despite not having a permit for that area.  My friend was in pain, especially in his shoulders and he slept badly.  I thought it odd that a few hours of paddling had put him in such agony.  The next day, he called canoeing an “extreme sport”.  A few years later, this same friend had to leave the mission field for a medical furlough.  His vision had clouded over and the diagnosis was Type II Diabetes; his hbA1C was 14%. He had undoubtedly been suffering from hyperglycemia and experienced a bout of severe tendonitis from our little excursion.

I remembered this story recently, as I was thinking back about the many sports injuries I myself had suffered trying to stay active to lose weight.  Peripheral neuropathy destroyed my ability to canoe–the tingling in my hands was too severe; it also hindered weight training.  Later, weight training became impossible when I experienced debilitating rotatory cuff tendonitis.  Often, after playing basketball, I couldn’t even walk for three to four days, and I frequently suffered from Achilles tendonitis, a couple times so bad that I needed crutches.  I had lost most of my flexibility, but if I stretched, I could cause severe injury to my tendons.

It is commonly thought that an effective treatment for diabetes is exercise.  That’s fine and may help, but if the patient has tendonitis, peripheral neuropathy, or loss of proprioception (loss of coordination–I often fell inexplicably when working around the house, walking up steps or when doing sports), then the devastating effects of high blood sugars would make exercise at best difficult at worst impossible.  Diabetics and prediabetics who like me suffer from tendonitis must first control their blood sugars before they can expect to exercise.  In his book, Why we get fat and what to do about it, Gary Taubes makes an important point:  We don’t get fat because we don’t exercise.  We don’t exercise because we are getting fat.  In other words, therapists (e.g., physicians and nutritionsts) who recommend losing weight and exercise to treat obesity and diabetes–i.e., the vast majority of the imbeciles who practice medicine and nutrition–have a buggy-driven horse.

As soon as I gained control of my blood sugars I began to notice major improvements.  After a couple weeks, though I had the energy to walk, I still suffered injury to my knees and Achilles tendons, but now these problems are much less severe after exercise.  Before I started to low-carb, I tried to do my rotator cuff exercises after a hiatus of many moons; I suffered an immediate relapse of the tendonitis which took a couple weeks to lessen.  It is clear to me that I couldn’t exercise to lose weight that way.  But now that my blood sugars have normalized after four months of low carbs, I can pretty much exercise every day as necessary.

I am exercising in the evening to achieve perfectly normal over-night blood sugars and I am having considerable success with it.   This is about fine tuning the blood sugars. That is impossible on a high carbohydrate diet, and it is often cruel to recommend to diabetics that they must exercise to control blood sugars.

I become angry when I read that diabetics and prediabetics must exercise and lose weight to control their diabetes.  Rather, those of us who suffer from hyperglycemia must first achieve normal blood sugars via low carbohydrate diet, and then the weight loss will take place naturally and exercise will become possible.  I look forward to going canoeing again now that my peripheral neuropathy is gone.

Could a ketogenic diet help prevent or even cure cancer?

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In 1977 my mother passed away from cancer at the age of 47.  I was thirteen and my little sister was eight.

Fairly recent research has shown remarkable facts about cancer cells (Gary Taubes, Good Calories, Bad Calories, ch. 13):  cancer cells use thirty times as much glucose as healthy cells because they depend on fermentation for energy.  Furthermore, they are not insulin resistant–when other cells in the body resist the efforts of insulin to import glucose for energy, cancer cells happily accept them.  Thus, cancer cells apparently thrive in people who have high levels of blood sugar (e.g., prediabetics who have glucose intolerance), for diabetics and prediabetics have a much higher rate of cancer than people with normal blood sugars.

So I ask myself if it would be possible to starve cancer cells to cure cancer or to prevent their appearance in the first place.  With a little bit of internet research, I found a some sources that may suggest this:  (1) A 2011 scientific study shows that a low carb diet could prevent cancer in lab mice; (2) Some claim that a ketogenic diet (i.e., a diet consisting of a absolute minimum of carbohydrates resulting in the burning of fat for energy) is a useful therapy against cancer, also in combination with traditional therapies (chemo or radiation).  One man claims that a ketogenic diet cured his cancer when doctors had given him only three months to live (see here).

Now the medical profession as a whole has been slow to accept low carb dieting, and this is much to their shame.  Personally, I’ve benefited from low carbing: I now enjoy normal blood sugars, normal blood pressure, 35 lbs of weight loss, and a significant attenuation of all my diabetic symptoms.  I feel better and I have hope that I may actually be able to live longer with much better health.

My mother was a physician and she had diabetes.  But I am certain that she did not have her blood sugars under control–our family ate rice everyday, along with other high carb foods.  Moreover, the technology to be able to monitor blood glucose at home did not exist before 1977. Dr. Richard K. Bernstein champions the Diabetes Solution, which requires diabetics to monitor their blood sugar several times a day and implement an ultra low carb diet (30 gm of carbs per day)–Dr. Bernstein only started using a portable glucose tester for the first time in 1969 (p. xvi).  The makers of this glucose tester designed it for hospital use only, but Dr. Bernstein, who was an engineer at the time, was able to obtain one through his wife who was a physician.  Then it took him a few years to perfect a technique for establishing normal blood sugars.  Today, many diabetics use his method to successfully maintain normal blood sugars.

It makes me wonder:  Had my mom been able to control her blood sugars, could she have prevented her cancer? I hope through this blog post to encourage low carb dieting as a legitimate effective therapy and preventative method–for many ailments related to diabetes, but perhaps also for cancer.  I think that this is where the research is leading us, and hopefully the medical profession will pay attention.

PS:  As I finished writing this post the news of Hugo Chavez’ death from cancer at age 58 has surfaced.  Undoubtedly, he suffered from metabolic syndrome, as his girth would suggest.