prediabetes

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.

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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.

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.

How I came to know that I am diabetic

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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.

Carbs are poison: carpal tunnel or peripheral neuropathy?

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Carbs are poison (for those with elevated glucose levels)

I’m going to start a new tag/category called “Carbs are Poison”. This is my new motivational motto as I have entered a major lifestyle change that took place two months ago.

About sixty days ago, I learned that the tingling I feel in my hands was related to elevated glucose levels in my blood stream. I’ve had this tingling in my hands for about ten years now, and it affects my comfort when driving, playing a guitar or ukelele, typing on a keyboard, and even holding a cell phone to my ear. I would have to lower my hands below my waist and shake them out to get rid of the tingling.

For years I thought that it was carpal tunnel, and generally speaking, my investigations into the question showed that carpal tunnel was work related, i.e., caused by repetitive use of, e.g., a keyboard or a jack hammer. But the more accurate term for my condition is peripheral neuropathy, a condition whose most common cause is diabetes. Once I learned this about two months ago, I was certain that I was diabetic.

Well, I also have four risk factors: I am (1) Asian, (2) obese, (3) over 40, and (4) I have a family history in that my brother, my mother, my grandmother and my grandfather all have/had type II diabetes. So I immediately went into get tested for diabetes and the hbA1c test came back 6.0, which means that I am prediabetic (between 5.6-6.9; 7.0 is considered diabetic).

But later, through reading Nikolaos Papanas, Aaron I. Vinik, and Dan Ziegler, “Neuropathy in prediabetes: does the clock start ticking early?” (Nat. Rev. Endocrinol. 7 [2011] 682-690), I confirmed that my symptoms were related to prediabetes–this is one that my physician couldn’t answer, “If I’m not diabetic, then why do my hands tingle?” The article shows that prediabetics with impaired glucose tolerance are more likely to have peripheral neuropathy and non-diabetics with peripheral neuropathy are likely to be prediabetic. The elevated glucose levels in the those with impaired glucose tolerance, i.e., those whose glucose levels don’t immediately come down from a high carb meal, can have the nerve damage that is related to peripheral neuropathy. The damage was so severe that I had for about one year started to experience severe arthritis in my finger joints.

It stands to reason that a low carb diet would have the benefit of helping me to control my glucose levels. I was especially informed by Dr. Richard Bernstein, who has made numerous appearances on Youtube. But I’ve also had some experience with low carb dieting in the past. So on November 28, 2012, I used the occasion of the twelve hour fast for my blood test, to begin a new low carb regimen. This is day 60, and here are the results so far:

  1. My blood glucose levels went down immediately from HbA1C 6.0% (=3 month average of about 7.7) in my blood test to about 5.4 (when testing with personal glucose tester).
  2. Within two weeks my blood pressure has come down from high (140/90) to normal levels (127/82).
  3. The tingling in my hands largely subsided immediately after beginning the low carb diet. At day 60, I’ve been typing at this keyboard for several minutes now, without any tingling.
  4. My arthritis is almost completely gone with some mild problems in only a few of the joints, particularly my right middle finger. Nevertheless, I can snap my fingers in both hands with no severe pain as before.
  5. I’ve lost about twenty-five pounds.
  6. I’ve come down two pants sizes, as my waist has shrunk from 43 to 39 inches.
  7. I feel less sleepy after eating.
  8. I have greater energy levels and enjoy exercising and long walks (except when my knees give me problems).

My low carb diet does require fat: it is not a low fat diet! However, I am consciously trying to eat only to satiety. I snack on low carb foods when I feel cravings or hunger between meals, but after the first few days, the intrusive thoughts of food and the cravings subsided. I now avoid all sugars and starches to the degree practical. Here are the main foods I avoid:

  • any thing with flour
  • bread
  • desserts with flour and sugar
  • potatos
  • carrots
  • lentils, beans, peas
  • sweet potatoes
  • milk
  • rice
  • candy
  • fruit

Here are some typical foods that I eat:

  • meat, fish, poultry (including the skin and organs)
  • spam, corned beef, sausages (kosher salami, summer sausage. pepperoni)
  • eggs
  • hard cheese (brie, gorganzola, blue, cheddar, gruyere, etc.), low carb/high fat yogurt
  • 18% table cream; whip cream (in home-made non-sugar, low-carb ice cream)
  • coconut milk or cream
  • tofu
  • pumpkin
  • onions and garlic
  • avocados (ca. 1 per day)
  • tomatoes
  • green vegetables: cabbage, lettuce, cauliflower, broccoli, eggplant, zucchini
  • olives
  • non-sweet pickled cucumbers and asparagus
  • mushrooms
  • turnips (small amounts in soup)

I am drinking no sweetened beverages. I have lowered my caffeine intake because I find that it stimulates the cravings for carbs. I drink a lot of water flavored with lemon or lime juice (e.g., Real Lemon), and now copious amounts of cold, weak green tea (1 tsp loose tea or 1 tea bag makes three litres). Since one is in a state of ketosis (using one’s own fat for energy), the low carb diet requires drinking a lot.

Finally, I am abstaining from alcoholic beverages for until I’ve reached my weight loss goal (at least 65 lbs–or down to about 180 lbs).