I sign with an M.D. after my name, but up until a couple of months ago I knew squat about diet and nutrition. I weigh 140# at 5'8", so have never given any thought to diet from a weight loss perspective. Along those lines, I have pummeled my pancreas with abandon for years, starting with a glass of OJ first thing in the morning for as long as I can remember. The simple carb infusions I used to punish my system with throughout the day surely led to insulin spikes on a regular basis. Diabetes, metabolic syndrome and insulin resistance were far off academic concepts to me.
Then I ran across some material on diet and the prevention of Alzheimer's disease. As I got more into it, it began to make a lot of sense. Finally, here is a subject related to diet that has caught my full attention. Who doesn't want a high performing brain into the eighth decade and beyond? I sure do. It turns out that the modern Western diet, as bad as it is for the pancreas, is equally horrible for brain health. Adults with Type 2 diabetes are at a 50% increased risk for Alzheimer's. And the main culprit? Simple carbs. And high fructose corn syrup is the worst actor. Of course, the subject is very complex, but I will see if I can give a cogent summary.
The term Type 3 diabetes has kept popping up. I'd never heard of it. Google that term and one of the first hits to come up is
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769828/ A review article from 2006, the lead author being from Warren Alpert Medical School at Brown university (
@Lorenzzo !). The brain can become insulin resistant, just like the rest of the body's systems, and if glucose is the primary fuel source presented to the brain, it starves. This brain's insulin resistance is one of the many manifestations of what has come to be known as Alzheimer's.
So, how does this relate to the OP? Until we understand how simple carbs affect our diet, basically all weight loss diets are doomed to failure. In homo sapiens' history, we were only presented with simple carbs in late summer and fall. The insulin hormonal system evolved to store those sugars as fat for the coming winter. Think bears, berries, and hibernation. American's per capita consumption of sugar in the 1950s, primarily derived from sugar beets and sugar cane, was something like 70# per year. These days it is something like 800# per year. Credit the food industry. From WebMD:
https://www.webmd.com/food-recipes/features/sugar-shockers-foods-surprisingly-high-in-sugar#1 Note: 4 gms of sugar = one teaspoon. Seriously- would you add 6.5 TEASPOONS of sugar to a cup of fruit sorbet??? Start reading food labels- sugar is EVERYWHERE. And these days life is complicated by high fructose corn syrup. The thing is: our systems at least recognize naturally occurring fructose and sucrose as substances our ancestors dealt with. However, our systems don't know what to do with high fructose corn syrup, so the only thing we can do with it is to turn it into fat. The food industry is doing an outstanding job of preparing us for winter. The problem is, winter never comes.
And I need to touch on ketosis. Eliminating simple carbs from the diet is a big first step and, strictly speaking, ketosis might not be necessary to incorporate into our lifestyle if weight loss is our primary focus. But it is a key factor if we have long term brain health as our goal. Dr Jason Fung, referenced above, is one of the rock stars in this arena. Dr David Perlmutter is another. Gut health (the microbiome) is another of Perlmutter's key focuses (foci?). If we eliminate simple carbs from our diet as something our body processes as fuel, we have to replace it with something else. It turns out that if the Alzheimer's brain is unable to process glucose as a fuel source, it does very well at utilizing ketone "bodies" as fuel. Dr Mary Newport is big in this arena, and she has a book based largely on her experience with her husband who was diagnosed with Alzheimer's at age 51. There has been a lot of noise in recent years about "burning fat" that I have mostly ignored. But there really is something to it. It's just that it takes a little effort as there is no pill that magically transforms us into fat burning machines. And N.B.- there is "good" fat and there is "bad" fat. Good fats include coconut oil, MCT (medium chain fatty acids) oil, avocados, fatty fishes (SMASH- for salmon, mackerel, anchovies, sardines and herring) and butter. Yes- BUTTER. But it must be from grass fed cows. That's absolutely critical. Grass fed butter is high in omega 3 fatty acids. Corporate farm butter is high in omega 6s. Omega 6 is not "bad" in of itself, but is bad if it is at too high a ratio with omega 3s. Dr Newport brought her husband back from dementia purely by giving him a couple of tablespoons of coconut oil per day. Sounds like hype, but it's true. Coconut oil is high in MCTs and they can be used efficiently as a primary fuel source. And the alternate pathway is completely independent of insulin. Dr Newport was desperate to find a treatment for her husband's dementia and happened upon some research into MCTs. Now, as a neonatologist pediatrician, she knew something about MCTs as they are a key ingredient in infant formula. She thought "what the heck, it can't hurt", and started her husband on coconut oil, with startling results. Here's the top YouTube hit when I input her name. I haven't watched this particular video, but she has been very compelling in other interviews I have seen her in
So, after this complete sidetrack, you might rightly ask: how does this relate to the OP? Well, first and foremost, recognize simple carbs as the big boogie man of the modern Western diet. Just say NO. That's probably enough to get things started. But if you want to incorporate ketosis into your lifestyle, it will take a little more work. Dr. Steve Fowkes, a biochemist and prominent lecturer on nutrition has said something along the lines of, "most individuals who are aging gracefully are in fat-burning mode". Dr Fung's intermittent fasting formula starts it off: fast for at least 12 hours, up to 16. At that point glucose and glycogen stores are depleted and you are in mild ketosis. Then avoid the temptation for a simple carb infusion. Substitute "good" fats and "real food". Michael Pollan defines that as anything your grandmother would recognize as food. However, I feel that as we progress further into the 21st century in the grip of the food industry, we probably need to default to what our great-grandmother would recognize. Pollan's mantra: "Eat food, not too much, mostly vegetables". Lots of colorful, above ground leafy vegetables. Generally raw. Small, wild caught oily fish. Small because they haven't been around long enough to concentrate mercury. Salmon, but it must also be wild caught. Farmed salmon are again high in omega 6s. Grass fed beef. Eggs laid by "pasture raised " chickens, who are actually allowed to run around picking up bugs and anything else that looks good to them to eat. Beware "Free range". It's not the same. Why? Again, it's the omega 3s.
I don't find this diet limiting in any significant way. And the funny thing is- when you eliminate simple carbs, you don't get hunger pangs. That growl in your stomach is driven by the hunger hormone ghrelin, which is secreted when carbs crash. Which happens after insulin spikes. Which happens when you bomb your system with simple carbs. It's a vicious circle. Jump off that merry go round for good. And don't look back.