Recommended Non-technical Dietary--JK

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Healing Obesity and Type-2 Diabetes: What To Do and Why

There are many different diets and fasting programs, what I have present below is found in the extensive body of published scientific research.  This paper is for an audience of the long-term obese, and those with type-2 diabetes (T2D).  I would start with the relevant basics science:  knowing the basics answers about the processes supports the recommendation of fasting and cutting refined carbs.  It is essentially consistent with Dr. Fung’s clinic practices and his search of the literature—to his videos. 

Healing Obesity and Type-2 Diabetes:  What To Do and Why

www.healthfully.org/rns/id6.html  rjk/8 10/27/16 (see first definitions on last page)

The systems and why it fails:  There are 2 main systems for producing the energy molecule ATP, one of burning glucose, the other of fats.  Obesity & T-2D (type-2 diabetes) result from defects in the fat-weight-regulatory system.  All mammals have a complex regulatory system for appetite, rate of metabolism, and fat storage.  There are over eighty hormones involved in the systems.  The Western diet has 25% calories from sugars (751 calories), mostly from sucrose.  The most reactive sugar is fructose; it is one half of the disaccharide sucrose.  It accumulates in the liver because that is where it is metabolized.  There it damages the liver through the process of glycation.  Glycation is the process of a sugar and its metabolites randomly attaching to proteins.  This damage in the liver causes insulin resistance (IR) which entails a higher than normal level of insulin is necessary to promote the uptake of blood glucose by cells throughout the body.  Refined & also easily digested carbohydrates such as from rice and potatoes accelerate the process leading to insulin resistance and fatty liver disease (NAFLD) because they cause a very high blood-glucose level.[1]  Insulin direct cells throughout the body to absorb blood glucose which the cells will burn (metabolize).  To promote glucose burning, insulin also signals cells to stop burning fat and thus STORE THE FAT.   Thus IR causes an excess in fat storage.   Some of that fat is stored in the liver, and in excess (2-3 pounds) this further damages the liver.  These stresses upon the liver (from glycation & excess fat) are what throws-out of balance the weight control system. Too much fat in the pancreas damages the pancreas causes T2D.  The US western diet averages 151 (USDA, 2000) pounds yearly of sugar has caused through liver damage a health disaster
 
A few more pieces to the system:  more on what you need to know are the causes so that you will know how fasting and low sugar diet fixes the weight-regulatory system.  Fructose is a 7.5 times more reactive than glucose, and it takes twice as long as glucose to be cleared from the liver; thus it damages the liver at 15 times the rate of glucose—overwhelms the protein repair system.  Experiments on volunteers have shown that high fructose diet causes liver inflammation in just 2 weeks.  Galactose from milk sugar lactose is also very reactive.  Incretins are hormones produced in the stomach and duodenum in response to foods.  They stimulate the release of insulin by the pancreas.  This explains why all foods cause the release of insulin even the ones that don’t have glucose (carbs).  See Insulin Table at the end for the amounts.  It is another reason why a very low carb diet fails long-term, because the insulin in response to proteins prevents the clearance of fat from the liver, pancreas, and other tissues.  Insulin also regulates the hormone leptin.  Having IR will over time result in leptin resistance (excess leptin).  Leptin produced by fat (adipose) tissue and functions to maintain at a fixed level of fat through its affects upon appetite and metabolism.  When the stored fat level drops, leptin functions to both increase appetite and cause a major reduction in metabolism—this usually happens at 2 months on a calorie or ketogenic (low carb) diet.  Fasting avoids this. This leptin system with other hormones functions to restore weight, a good thing if you are thin, but a bad thing if you are long-term overweight.  This leptin production by fat tissues explains why it is so hard for some people to lose weight and keep it off—the yo-yo diets.  Western diet has through excess insulin (IR) made many of us overweight, obese, and diabetic.  Exercise more and eat less doesn’t fix the system.

[1] Note:  those who eat a very low sugar diet, such as the traditional diet of the Japanese do not develop IR or NAFLD, and therefore have a very low--compared to those on the Western diet—incidence of T2D, heart attack and obesity (sugar is only 14 grams a day).

The fix:  Cleanse the fatty liver & pancreas through extended periods of low insulin.  At night after the food has been digested and blood glucose returns to the fasting level (which is what your doctor measures with blood work in the morning) the body is metabolizing fats because insulin is low.  This period of fat burning, if frequent and long enough, will burn the excess fat in the liver and pancreas.  When on a low carb/sugar diet helped along by fasting, this will permit the liver and pancreas to heal and function normally:  the cure for NAFLD, IR and T2D.  Merely low carb or low calories will not keep insulin low because of a hormone system involving incretins that raise insulin when proteins are in the stomach and intestines.  Insulin also causes fat tissue to release the hormone leptin which functions to restore the fat by increasing appetite and lowering metabolism.  Remember, leptin is secreted in response to insulin.  Fasting enhanced by low carbs avoids the drop in metabolism that occurs through leptin to restore fat. Cleansing the liver of fat prevents the yo-yo diet.  

What you probably won’t hear this from your doctors and corporate media:  Medical schools do not have a course in nutrition.  The influence of the pharma and food manufacturers also extends to clinical trials and who rises to be a key opinion leaders and what they teach.  Because it is not in their financial interest to fix the NAFLD and IR with diet and thereby prevent all the comorbidities, your doctor is taught that the ketogenic diet is dangerous, fasting doesn’t work, and he will advises you to eat less and exercise more.  The same message is taught dieticians and repeated in the corporate press.  They are taught the fix is to eat less and exercise more and for diabetes to tightly manage glucose with drugs, and that diabetes is a progressive disease.  It is tragic that industries are allowed in our corporatist state to pollute the evidence, corrupt medical education, and clinical practices. 

Short fast (SF):  go on a 16 hour fast (7 PM until 11:00 AM) or longer, thus extending nighttime fat burning to midday.  At night because of not eating there is low glucose and thus low insulin.   If hunger becomes an issue, than drink tea or coffee without sweeteners or milk.  Yes, no artificial sweeteners[1].  If quite hungry then eat a little celery or like greens, preferable without cheese or peanut butter, or similar small snack.  If progress is slow than lower carbs more and progress to the alternate day fasting.  You can still delay your first meal on the non-fasting days.  Choose whichever fast has the best compliance, Dr. Fung prefers alternate day fasting, but uses either based upon compliance.    

The fat burning diet: It starts in the supermarket: buy low net carb foods (net carbs = total carbohydrates minus fiber content in grams), and clean out your cupboards and fridge.  It is easier to say “no” in the market then in the kitchen.  We are a social animal, thus enlist the support of your family and friends.  A positive vicarious social contact arises from watching the diet and diabetes documentaries and lectures on YouTube; and it enlists the support of the rational side of your brain.  An extensive list of YouTube videos with description is at http://healthfully.org/rh/id7.html.  Keep a log of your diet and fasting including how you feel.  Start the log a couple of weeks before starting your diet and fasting.  For some the gradual approach is best.  With this method you can reduce your carbs gradually and substitute corn syrup for sugar.  Karo is the leading brand; it is pure glucose (no fructose).  Biologically it is equivalent to rice and potatoes.  It took me 3 months to lose my craving for sweets; a year to reduce to 1/3rd refined carbs—and I have always been slim.   Right from the start I increased saturated fats (butter) to replace the reduction in carbs. Yes, fats are much better for you than refined carbs and yes, saturated fats are the best, followed by monounsaturated fats.  (See links section below for the science behind why saturated fats are much better than the cheap unhealthy processed polyunsaturated fats which food manufactures along with added sugars use).  To obtain the long periods of low insulin requires fasting.  An early, small dinner, low in carbs and high fat, moderate protein[2] entails more hours at night in the fat-burning state.  If short-term fasting isn’t working to cure T2D and obesity, then switch to alternate day fasting and continue to reduce the carbohydrates.



[1] Artificial sweeteners have been shown to stimulate the signal the release of insulin through taste buds on the tongue.

[2] Proteins in meats fish and poultry and an intermediate high insulin index number though they don’t have carbs because of the incretin system—see Insulin Index table at end.  This is why calorie restricted and very low carb diets for the long-term obese nearly always fail because they don’t cleanse the liver.  This requires fast.    

Additional good diet practices: 

Short-term fast, don’t eat after 7 PM and skip breakfast, or longer if progress is slow. 

 Low net carbs

To lower insulin spike when eating refined carbs include a liberal dose of fat (incretin hormones stimulate insulin release, thus pasta has a lower insulin index than meats, fish or poultry). 

Exercise prior to and subsequent to eating, thus lowering blood glucose and thus insulin

Smaller meals have lower insulin spike and quicker clearance from gastro-intestinal track

Preferentially buy carbs that are high in resistant starches (see /rh/id3.html) such as from legumes and fiber-rich green-leafy vegetables

Increase saturated & monounsaturated fats to supply the energy that carbs were supplying & greater satiety (avoid polyunsaturated because of rancidification in our body). 

Avoid the products of the food manufactures; for they are have added sugar, refined carbs, polyunsaturated and trans-fats, and chemical additives 

At meal-time eat slowly and stop before stuffed.

Have handy small low carb snacks to kill hunger pangs, and limit size if high in protein.

LINKS: The best source on what to eat for health, for diet, and related topics is at Concise.  In the rh section are articles which lay out the evidence for what is found there and dja has journal articles on rancid fats, diet, etc.  Important are Part 5 on supplements, Part 6 which covers many of the topics here, and Part 10 on the New Atkins low-carb diet.  The large Videos library with brief descriptions has links to YouTube.  It confirms the claims here--and other health topic.  The links to ABC, CBC, BBC, ABC again national networks; they expose what U.S. media hides.  The leading authority with results is Dr. Fung of Toronto; his videos on YouTube are on fasting, T2D, fats, & insulin.   I highly recommend his book “The Obesity Code:  Unlocking The Secretes of Weight Loss” (a book on fasting is coming out in October of 2016).  For those with T2D, for a minimal fee your he will work with your doctor, click on the link to his clinic.

Definitions:  body & food basics 

Adipocytes (lipocytes) fat cells compose adipose tissue & secrete hormones resistin, adiponectin, leptin and apelin.  

ATP, Adenosine TriPhosphate (adenosine with 3 phosphate molecules (PO4) attached), transfers chemical energy within the cell through the loss of one of its phosphate groups.  In the mitochondria ADP returns to the high energy state ATP 3(PO4) through absorbing energy from the metabolism of carbohydrates & fats.  ATP provides the energy for over 90% of the biosynthesis:  for muscle contraction, hormones, collagen, etc. and for intra and intercellular active transport.

Cardiovascular disease (CVD) causes cigarettes and a high sugar diet which cause endothelial dysfunction of the artery walls.  These cells permit pathogens to colonize in the artery walls to cause inflammation, atherosclerosis, and CVD.

Carbohydrate (carb):  fiber, fructose, glucose-glycogen, starch, sucrose, lactose, net carbs (total carbs minus fiber):

Fiber, vegetable fiber, roughage, the carbohydrate component not broken down by digestive enzymes, but some is by gut bacteria.  Fiber has more than ten sugar units.  It lowers the insulin spike when consumed with refined carbs. 

Fructose (fruit sugar) a monosaccharide found in fruits.  Main sources are the disaccharide sucrose, fruits, and high   fructose corn syrup.  It is metabolized in the liver into either glucose, or fat which when insulin is stored there to cause fatty liver.  Also fructose is 7.5 more reactive then glucose and by glycation damages the liver, etc.

Glucose a monosaccharide is the main energy storage molecule for plants; in humans 1-2-lbs is stored as long-chain glycogen a backup energy source stored in muscles, fat, and liver cells.  Glucose is as one half of sucrose, and is also obtained from the hydrolysis of the digestible starches.  Glucose and fat are the main sources for production of ATP.

 Starch is long chains of glucose units.  This polysaccharide is produced mostly by green plants for energy storage. 

 Sucrose, table sugar, produced by plants; it is the readily hydrolyzed disaccharide consisting of fructose and glucose. 

Glycation:  a process where a monosaccharide (simple sugar) randomly attaches to proteins or lipid; this adversely affects their functions, thus glycation is a major cause of our chronic age-related diseases. 

Diabesity:  the combination of diabetes and obesity that afflicts those on the Western diet—a recently coined term. 

Fat (Free Fatty acids and triglycerides): up to 24 carbon molecules with an organic acid or glycerol molecule on end.

Incretin: class of hormones secreted by the stomach and intestines which causes insulin secretion and produces satiety.

Insulin: a gateway hormone is produced by the pancreas.  Its main function is to have cells absorb glucose and store fat.  Cells already loaded with glucose, to prevent toxic level resist the message by insulin to absorb more glucose.  Insulin also regulates other enzymes and hormones including leptin.  Low insulin is the cause of type 1 and 2 diabetes.  Insulin also promotes the storage in amino acid, and thus we secret insulin by the incretin system in response to proteins. 

Insulin resistance (IR):   a condition of higher than normal amount of blood insulin to lower blood glucose due to a diminished response to insulin by various tissues.  The pancreas then releases even more insulin to lower blood glucose.  IR is the condition which causes the fat accumulation in the liver and pancreas and obesity, and all their comorbidities.

Ketogenic diet (very low carbohydrate diet):  it forces the body to rely upon just fats to convert ADP to ATP to cause weight loss without restricting calories.  It is named refers to the ketones produced in this metabolic natural process.

Key Opinion Leaders (KOLs):  people who rise to top positions in their area of expertise.  In fields relevant to business some of these people violate the standards of science to produce and spread business-favorable spin, and are handsome rewarded for their services.  The term is used in that sense of bad conduct.  Pharma has used KOLs along with regulatory capture to produce a drug disaster while selling it to medical students, physicians, politicians, and the public as cutting edge science.   

Leptin:  produced by fat cells is in part regulated by insulin.  Leptin in the brain suppresses appetite and it also regulates metabolism.  Leptin is responsible for the 25% reduction in metabolism plus increased appetite that eventually occurs during an energy-restricted diet.  Leptin functions to maintain fat storage and to restore weight even years later.  

Lipids are a group of naturally occurring fat like molecules including waxes, sterols, fats, phospholipids, and others.

Metabolism in reference to diet refers to the metabolic use of mainly either fat or carbohydrate to convert ADP to the high energy molecule ATP mostly by the mitochondria.  During  starvation proteins also can be used to make ATP.

NAFLD (Non-Alcoholic Fatty Liver Disease):  the accumulation of fat by liver cells sufficient to significantly downgrade their various functions.  The NHANES survey 2011 found NAFLD in 30% of adult population—similar % for Europe. 

Type-2 diabetes (T2D): occurs when the pancreas fails to produce enough insulin to lower glucose to its normal range; it results from chronic IR and the accumulation of fat in the pancreas which eventually causes the decline in insulin.

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Why the global diabesity (obesity & diabetes) pandemic:  We are living with the results of perverse system which places profits before people, while of course pretending to serve us first.  Thus what we are told about diet is based on what is good for the food manufacturers, and it is sold to us as heart and body healthy.  Refined carbs (especially sugars) are the cause of the global diabesity (obesity & diabetes) pandemic.  The healthful saturated fats have been demonized and thus replaced with the unhealthy, cheaper polyunsaturated fats and trans-fats.  Then we were advised to cut fats, thus those calories were replaced with refined carbs, most of which are supplied by the food manufacturers.  At the same time fruits were bred to be higher in sugars.  They knew of the neural mechanism which makes sweetness positively reinforcing and addicting, thus the food manufactures steadily increased the amount of sugars in their products.  The result is for the US, an average of 151 pounds of sugars per person per year.  Over half of our population consumes even more.  Unlike paleo peoples whose fruits are far less sweet and seasonal, our sugars and refined carbs are year round.  Often through scarcity, they are forced to fast.  We have the perfect storm of a steady diet high in sugar which damages the liver and a high carb diet that promotes more damage to the liver by slowing its metabolism in the liver, plus unnatural highly processed polyunsaturated vegetable oils,[1] and not fasting.  Cancer, cardiovascular disease, strokes, heart attacks, T2D, Alzheimer’s disease, macular degeneration, diabetes, osteoporosis, ulcers, colitis, and arthritis are all quite rare among the elderly paleo peoples on traditional diets, and there is great variation depending on region (compare the Intuits of Canada to those living on pacific islands with their taro as staple starch).  Year-long high sugar diet is the primary cause.  . 

Each portion of food contained 240 Calories—score relative to white bread which was set at 100

Peanuts                   20

 

Fish                            59

 

Grapes                           82

Eggs                          31

 

Oranges                    69

 

Crackers                         87

All bran                    32

 

Potato chips            61

 

Ice cream                       89

Porridge                  40

 

Brown rice               62  

 

Cookies                          92

Brown Pasta          40

 

Special K                   66

 

Whole Bread                96

White Pasta           40

 

Honey smacks         67

 

White Bread               100

Cheese                    45

 

Coco Pops                71 

 

Yogurt sweetened    115

Granola plain         46

 

French Fries             74

 

Baked Beans can       120

Beef                         51

 

Corn Flakes              75

 

Potatoes                      121

Popcorn                  54

 

Croissants                79

 

Mars Bar                      122

Grain bread            56

 

White Rice               79

 

Jelly Beans                  160

Lentils                      58

 

Bananas                   81

 

Fats                                  10

Apples                     59

 

Cake                          82

 

 

from http://graemethomasonline.com/wp-content/uploads/2010/06/Insulin-Index.pdf

Detail explanation of testing  http://www.janurky.sk/db/articles/20150703n0(kj_not_kj)/images/insulin_index.pdf

These figures are based on test results for an ideal group:  average age 22 and BMI of 23.  Foods needing preparation such as potatoes and pasta were boiled, stored overnight in the refrigerator then warmed the next day in a microwave.  Test score was based on the average insulin level over 120 minutes divided by that for white bread times 100.   There were 503 tests total test for the 36 listed foods.  Breakfast cereals were served with milk.  “Plasma insulin concentrations were measured in duplicate by using an antibody-coated tube radio-inmmuonoassy kit (Coat-A-Count; Diagnostic Products Corporation, Los Angeles)”at 1997, p. 1295.  Samples of 1.5 to 2.5 mL. of blood were obtained at 15 minute intervals over the 2 hours test period.  Unfortunately this table lacks important foods of vegetables, milk, soda, diet soda, and fat (which I included from another source--Dr. Fung’s book The Obesity Code p 193).                                                                                                                                                                            

The goal is to maximize the rate of fat burning which requires a low insulin diet.  Insulin causes fat storage.   Since protein is needed to maintain muscle mass, it must be restricted but only somewhat.  The USDA dietary recommendations are high.  Thus I recommend cutting it to 35 grams women, and 45 grams men--for those of average body frame size.  This is sufficient to prevent muscle loss.[2]  The effect of protein upon insulin and thus fat storage explains why short-term and alternate day fasting make a very significant improvement upon the low carb ketogenic diet.[3]  For most on a ketogenic diet, after a couple of months the rate of weight loss will decline, the effect of insulin upon leptin.  Fasting prevents this phenomenon.



[1] Most authorities know of the health issues with trans-fats; however, they miss the fact that polyunsaturated facts are subject to rancidification (oxidation) in the body and while cooking.—a thing known for over 5 decades.  Oxidized polyunsaturated fats are comparable to trans fats in that they don’t work as well as natural fats.  A large body of research exposes this danger.  And polyunsaturated fats from grains are high in omega 6 oils which block the healthful omega 3.  

[2] The science on the effects of elevated insulin due to protein when carbs are low is very incomplete.  For one thing, with a high-protein-low carb diet (once popular in the 1920s and before) proved successful.  Obviously the when there is no glucose to burn the body will continue to burn fat; however there could be for those who don’t fast a point where metabolism declines. 

[3] There is a second hormonal system, one not affected by glucose, stimulating the release of insulin from the pancreas.

The advice here is merely what JK would do in those situations. See your doctor for medical advice.

The only thing necessary for the triumph of evil is for good men to do nothing--Edmond Burke

Perverse systems grow by recruiting good men--jk

Everybody thinks they know what good is, but they are confused--Plato

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