A ketogenic diet as a preventative and treatment for malaria

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?

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.


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.

How I came to know that I am diabetic

Last November I realized that I had diabetes.  For years I’ve worried about becoming diabetic because it runs in my family.  Since about last summer, I’ve suspected that I might be diabetic but put off going to the doctor, for the ailments from which I suffered were not so acute that I felt compelled to consult the medical profession.  A good friend who is a missionary in Africa told me last Spring that he had returned to the US to deal with his failing health and learned that he was diabetic.  When he described his symptoms, such as constant thirst and blurred vision, I wondered if I too was becoming diabetic.

Finally, it came to a head in November because my wife asked me to put some carriage lights up on our garage.  After the first weekend of some minor work around the garage, my feet were in pain which seemed disproportionate to the level of exertion.  Not only so, but I fell off the ladder twice and also stumbled on the last step leading down to the garage.  I was wondering if this lack of co-ordination could have anything to do with diabetes.  So I looked it up and found that it was so.  I then investigated each of my other problems to see if there was a relation to diabetes and concluded that I had such a convergence of symptoms that I should get myself tested.

Pre-Diabetes or just Diabetes?

So I went to a walk-in clinic and asked to be tested for diabetes.  The physician took my blood pressure and filled out an order for blood work which she told me to take to nearby blood lab after fasting twelve hours.  When the lab work returned the clinic called me back in to inform me that I was not diabetic.  My blood worked showed a HbA1C of 6.0 and fasting glucose of 6.0 (108).  All clear, the doctor said.  But since I had elevated cholesterol levels he suggested avoiding saturated fat, high cholesterol foods, and since uric acid levels were higher than normal, he suggested eating less red meat.  (On my low carb diet, I’m actually doing nearly the opposite of what he suggested).

If not diabetic, I asked him, then why did I have symptoms (viz. peripheral neuropathy) consistent with diabetes.  He seemed to have no answer.  One conspicuous problem with his diagnosis, was that he did not even mention prediabetes.  Prediabetes is a condition of having abnormally high blood sugar but not at levels that the medical profession or the diabetes associations would consider diabetic.  At present, however, there is some dispute as to the accuracy of the term “prediabetes” since some therapists today would consider it only a milder form of diabetes.  Indeed, Dr. Richard Bernstein, who has a very successful practice of helping his patients control their glucose levels, says that he would treat prediabetics as diabetics (see The Diabetes Solution, p. 35).  I conclude that prediabetes is merely a less severe form of diabetes.  The prediabetic’s glucose levels are above normal but not so high that the medical profession, in general, is happy treating you.  You aren’t dying fast enough for them.  To be sure, I was sick, but not sick enough.  To relieve any doubt that I am diabetic, I will now explain the many diabetic symptoms that I had which are caused by elevated blood sugars, and I urge anyone with the same symptoms to take them more seriously than I did.  The websites which I link to are by no means definitive but merely representative expressions of how each symptom is potentially caused by diabetes.

My Diabetic Symptoms
citizenship day

On citizenship day, 28 February 2011, Petros showing visceral obesity

  1. Obesity:  According to Gary Taubes’ research, the main cause of obesity is insulin resistance resulting in elevated blood sugars.  This is also what causes the cravings and any excessive eating.  Thus, obesity is a symptom not a cause of diabetes.  I was 65 lbs overweight and had a waist measurement (pants size, i.e., not true waist) of about 43 inches.  The pot belly (a.k.a. visceral obesity) is the most dangerous form of obesity.  I have struggled with my weight during my childhood and it started to become a problem again in my late twenties.
  2. High blood pressure:  In November when the physician tested me, I had a reading of 140/90.
  3. Peripheral neuropathy:  I had frequent and debilitating tingling in my hands when holding steering wheel, canoeing, playing guitar, or typing on a keyboard.  I’ve had this problem for about the last ten years. Peripheral neuropathy also probably explains the pain I had in my feet after doing the work in the garage.
  4. Skin Tags: I seemed to be getting a large number of these in the last few months.
  5. Dizziness:  I had a single incident of dizziness last summer that caused me considerable concern.
  6. Sleepiness:  I became sleepy after every meal except, most of the time, breakfast.
  7. Dry mouth and bad breath:  I experienced dry mouth that drinking seemed to help only a little.  Also, my wife began to complain that I had persistent bad breath.
  8. Loss of proprioception:  This is also related to peripheral neuropathy.  But I felt that I should explain why I fell three times as I explained above.  Proprioception is the sense of where the different parts of your body are, and I had apparently lost some of my sense of where my feet were and where they were going.
  9. Scalp acne: I have had chronic scalp acne for about ten years.
  10. Diabetic dermopathy (shin spots) and other sores that take a long time to heal.  I have a line of about four inches long of scars on both legs, right along where the shin bone is closest to the surface of the skin, which was caused by frequent scabbing.  I only learned today that this condition is called shin spots or diabetic dermopathy.
  11. Arthritis:  My pain was similar to a basketball injury of spraining a finger (finger jam).  But I couldn’t remember injuring myself.  But it was so severe in both hands that, if I shook hands with someone, I would winced in pain.  It wasn’t until I went on the low carb diet and lowered my glucose levels that I realized this arthritis was related to diabetes, because it has nearly completely disappeared.  I had had the arthritis for about 9-12 months.
  12. Athlete’s foot:  I have this condition frequently; blood sugars apparently feed the fungus.
  13. Ingrown toenail infection:  I had my worst infection ever last Fall.
  14. Tendonitis:  I had a couple years ago a very bad rotator cuff tendonitis and often experienced severe achilles heal tendonitis.  These injuries occurred especially when I was a member of a gym.  Here is the dilemma:  I thought that exercise was necessary for weight control but my high blood sugars were making it difficult to exercise.  Now I am able to control my weight through low carb dieting, and I believe I will be less susceptible to injuries.

These symptoms are all related to elevated glucose levels, and many of them are going away now that I am on a low carb diet leading to much lower blood sugar levels.  While in the prediabetic range, my average blood sugar was nearly double normal.  The percentage of glycated hemoglobin (HbA1C) of 6.0 showed that I had an average glucose of 7.8 (141) for the last three months, while normal levels are much lower (4.6 (83) fasting glucose is normal).  So for quite a number of years, my glucose levels were causing problems to my nerves, to my skin, and likely to many other tissues and systems.  Problems to the kidneys and arteries, for example, are less discernible but much more dangerous.  So it is important to take visible manifestations seriously and to control them through the reduced intake of carbohydrates.  Carbs are poison.  Well, they are to those with diabetes, even those like myself who are in the prediabetic range.