Amanda Atkins - a personal story
August 2016
I was dragged to my doctor by a friend concerned about my persistent cough which had everyone worried,
I had lung cancer (I'm not a smoker).
On the Monday day, I was diagnosed with T2 diabetes, I was told it was "severe" - I found out my Hba1C was 10.3%, fasting glucose was 18 mmol, my doctor said: “we must start insulin immediately... come back on Friday to see the diabetic team”.
I went home, checked my will and googled "severe diabetes". I am forever grateful that my doctor used the word "severe".
This paper came up in my first search.
I am an accountant, a layman who at that stage knew less than nothing about nutrition, metabolism, or anything else to do with how my body actually functioned. I was lucky this paper was written by someone who likes Dr Unwin, could explain things to the lay public.
Abstract: "We previously demonstrated that a loosely restricted 45%-carbohydrate diet led to greater reduction in hemoglobin A1c (HbA1c) compared to high-carbohydrate diets in outpatients with mild type 2 diabetes (mean HbA1c level: 7.4%) over 2 years.
To determine whether good glycaemic control can be achieved with a 30%-carbohydrate diet in severe type 2 diabetes, 33 outpatients (15 males, 18 females, mean age: 59 yrs.) with HbA1c levels of 9.0% or above were instructed to follow a low-carbohydrate diet (1852 kcal; %CHO:fat:protein = 30:44:20) for 6 months in an outpatient clinic and were followed to assess their HbA1c levels, body mass index and doses of antidiabetic drugs.
HbA1c levels decreased sharply from a baseline of 10.9 ± 1.6% to 7.8 ± 1.5% at 3 months and to 7.4 ± 1.4% at 6 months.
Body mass index decreased slightly from baseline (23.8 ± 3.3) to 6 months (23.5 ± 3.4).
Only two patients dropped out.
No adverse effects were observed except for mild constipation.
The number of patients on sulfonylureas decreased from 7 at baseline to 2 at 6 months. No patient required inpatient care or insulin therapy.
In summary, the 30%-carbohydrate diet over 6 months led to a remarkable reduction in HbA1c levels, even among outpatients with severe type 2 diabetes, without any insulin therapy, hospital care or increase in sulfonylureas. The effectiveness of the diet may be comparable to that of insulin therapy."
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My takeaway from this abstract was:
a) I need to reduce carbohydrates in my diet – now!
b) Whilst losing weight would be good, I could still improve my T2 diabetes even if I can't lose weight - which was good news as I have never found that easy.
c) I might not need to take the insulin that I was being told I would begin on Friday (4 days later).
d) this study was done in 2009 - it was now 2016 and yet my doctor didn't mention anything about this.
I checked out Haimoto - lots of other research - seemed to be a well-respected scientist in Japan. I knew zero about nutrition or science but this looked an interesting avenue to follow up - so far so good.
I read further.
"Carbohydrate-restricted diets (CRDs) have been reported to be effective for glycaemic control [1–7] in type 2 diabetes (T2DM). We recently demonstrated that a loosely restricted 45%-carbohydrate diet (carbohydrate-reduced diet: CRD) led to a significant reduction in haemoglobin A1c (HbA1c) levels with a tapering off of sulfonylureas compared to a 60%-carbohydrate diet (high-carbohydrate diet: HCD) over 2 years among outpatients with mild T2DM (mean HbA1c = 7.4%) [8].
Little is known about the long-term effects of CRDs on patients with severe T2DM. We therefore tried to determine whether good glycaemic control can be achieved with a stricter CRD (30%-carbohydrate), even in outpatients with severe T2DM in an outpatient clinic."
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I have spent a lifetime on a diet yo-yoing up and down, feeling guilty every time I ate something, being ridiculously hungry despite eating too much. I was an expert user of chronometer. It was set to highlight limiting calories, restricting fat. At all costs do not eat too much.
I went into my 10 years of data on chronometer and sure enough what did I find? A calorie restricted 60% + carbohydrate diet interspersed between episodes of no data because that is when I fell off the wagon and my weight yo-yo’s.
As it happens, I had been on a diet (again) since the beginning of August 2016. It had been very successful I was nearly 5kg down in two weeks. But now I knew my blood sugars had shot up. I rechecked what I had eaten - vegetable curry including root vegetables with bean sprouts. Huge volume hardly any calories almost entirely carbohydrates. Great for weight loss - but I began to feel very foolish. How could I, a 58-year-old woman, not have the slightest idea that this, all on its own, would make my blood sugars go sky high and that that was really bad news?
So, what did these Japanese researchers do?
I was intrigued now.
Patients and methods.
"We recruited outpatients with T2DM having HbA1c levels of 9.0% or above between September 2005 and September 2007 in Haimoto Clinic, and followed their HbA1c levels, body mass index (BMI) and doses of antidiabetic drugs monthly for 6 months. We also followed their serum lipid profiles, serum creatinine and blood pressure.
Patients with serum creatinine levels > 1.5 mg/dl, severe diabetes complications (proliferative retinopathy, symptomatic neuropathy and diabetic foot), ketoacidosis, soft drink ketosis [9] and malignant tumor were excluded. Five patients who developed ketosis received fluid therapy for a few days, and did not require any inpatient care or insulin therapy. We intended to taper the dose of sulfonylureas as soon as the patients' HbA1c levels were controlled, and to prescribe metformin, acarbose and pioglitazone. The patients were instructed to maintain their usual level of physical activity throughout the study. Changes in activity levels were investigated by questionnaire. The study protocol was identical to that of the previous study [8] and was approved by the Ethical Committee of the Nagoya Tokusyukai General Hospital. All patients provided written informed consent."
The main principle of the CRD was to eliminate carbohydrate-rich food twice a day at breakfast and dinner, or eliminate it three times a day at breakfast, lunch and dinner.
Table 1 shows the list of foods that the subjects were instructed to avoid. There were no other restrictions. Patients on the CRD were permitted to eat as much protein and fat as they wanted, including saturated fat. Their details were described previously [8]. At the end of the study, dietary intake was assessed based on 3-day food records. Changes in HbA1c and BMI were assessed by the Friedman test, and changes in serum LDL-cholesterol, HDL-cholesterol, triglyceride, creatinine and blood pressure were assessed by the paired t-test."
I looked at Table 1 - only 66 words were necessary to describe the foods they had asked patients to remove.
Table 1. Carbohydrate-rich foods instructed to remove in the carbohydrate-reduced diet.
Staple foods:
Rice, bread, corn, spaghetti, noodle made of wheat or buckwheat, potato, sweet potato, taro and yam.
Fruits:
Pear, apple, persimmon, mikan, orange, grapefruit, peach, grape, melon, water melon, banana, pineapple and Japanese chestnut, etc.
Vegetables:
Carrot, Indian lotus, pumpkin and autumn squash.
Confectioneries
Drink:
beverages containing sugar, glucose and fructose, and milk
Alcohol brew:
Sake, beer and wine (Distilled liquor was not restricted.)
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I looked up those foods on Cronometer. I looked up a few other foods that I liked but that didn't appear in the table but which I suspected would have been listed, had this particular study not been focused on the Japanese - it was soon clear - ditch starches and root vegetables, most fruits and all grains.
It had been a terrible day so far, I was beginning to feel a little better now though, I read the last sentence and drank my first ever (but not last) shot of single Malta whisky (in moderation of course).
Simple. I read on....
Results
" Thirty-three patients participated in this study. Background characteristics of the patients are shown in Table 2.
Two patients (6%) on the CRD dropped out after 4 months.
Of the remaining 31 patients, the total energy intake (mean ± SD) was 1852 ± 549 kcal/day (Table 3). The daily average intakes of carbohydrate, fat and protein were 137 ± 41 g (30 ± 10% of total energy), 91 ± 34 g (44 ± 10%) and 91 ± 30 g (20 ± 4%), respectively, with the mean fiber intake being 14 ± 6 g.
The carbohydrates were mainly derived from rice and noodles made from wheat or buckwheat, and also from potatoes, fruits, bread and confectioneries."
On average, the 31 people were eating 44% fat, 20% Protein and 30% carbohydrates and the balance fiber.
Bearing in mind these people hadn't lost weight, they had dramatically improved their Hba1C and whilst I still didn't have the slightest idea what that meant, their opening numbers seemed to be similar to mine.... So, on we go....
Results
"The mean HbA1c level decreased sharply from baseline (10.9 ± 1.6%) to 7.8 ± 1.5% at 3 months, and then more gradually to 7.4 ± 1.4% at 6 months (P < 0.001) (Table 4 and Figure 1). BMI slightly decreased over 6 months, but the decrease did not reach statistical significance (P = 0.057) (Table 4 and Figure 2).
HbA1c levels of the two drop-out patients were 13.0% and 9.5% at baseline, which decreased to 8.6% and 8.1% after 3 months but returned to 12.6% and 8.6% after 6 months, respectively.
When the two patients were excluded, the mean HbA1c level after 6 months was 7.2 ± 1.0%. No adverse effect was observed except for mild constipation."
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This study is unusual in that, it also shows data for each participant (I do so wish other would do that too). Those two individuals stuck out like a sore thumb in Figure 1.
But one other line caught my eye in this graph. How on earth had someone gone from 14%+ continued reducing after the half way mark (many others had started to rebound a little) to under 6% at months - who was that person- what did he/she do? Back to the write up.
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" One female patient had an increased physical activity level during the study period in spite of our instructions. However, her increase in physical activity was no more than one hour of walking per day, four days a week. She had implemented an 11%-carbohydrate diet without any antidiabetic drug, and her HbA1c level decreased from 14.4% at baseline to 6.1% after 3 months and had been maintained at 5.5% after 6 months. "
BINGO!
If a Japanese lady can do it - then so can I. After all we are all homo sapiens and just like all pandas eat the same diet, I suspect so could all homo sapiens. If it worked for her then it could work for me, I would just do what she did.
but wait, is getting rid of the foods encompassed in those 66 words gonna kill me? (is she dead already?) in some as yet unspecified way?
What about.... Cholesterol LDL?
I knew nothing except high LDL = bad.
On balance mean LDL seemed to be going down and indeed of the few that went up, it did seem to include the two people who had ignored the advice and then probably seen their Hba1C start to shoot up. Why can't the researchers make it clear what line refers to which individual instead of me having to guess?
"Ten patients had already been prescribed antidiabetic drugs by other physicians at baseline. The number of patients who were on sulfonylureas decreased over 6 months (glipalamide: from 6 to 1, glimepiride: from 1 to 0, tolbutamide: from 0 to 1) (Table 4). Of the 31 patients, 12 received other antidiabetic drugs at the end of the study; a relatively low dose of metformin or miglitol was mainly prescribed. No patient required inpatient care or insulin therapy.
Excluding 4 patients who were prescribed the lipid-lowering drugs during the study period, the mean serum LDL-cholesterol levels of the subjects decreased (P = 0.036) (Table 4 and Figure 3), while their mean HDL-cholesterol levels increased (P = 0.008) over 6 months (Table 4 and Figure 4). The mean serum triglyceride concentrations decreased over 6 months, but the change did not reach statistical significance (P = 0.39) (Table 4). We found no significant change in serum creatinine. Eleven patients were prescribed antihypertensive drugs during the study period. No significant change was detected in systolic and diastolic blood pressure."
Hmm, this looks very promising - no patient needed insulin therapy?
Mean LDL went down.
Mean HDL increased.
I'm pretty sure that is good news on both counts. I know now that "mean serum triglyceride decreased" is as important as either - at the time it meant nothing to me.
Serum HDL Cholesterol
Once again, things seem to be pretty much going in the right direction. A couple of down errors again seem to be the same colours as the two people where everything went wrong who had given up. I couldn't specifically find my splendid lady with the purple line though looking at the others it seemed like a reasonable guess that she would be one of the healthy increases (why, oh why...?).
Amanda Atkins - a personal story
Discussions with my doctor
On the appointed Friday, I went back to my doctor. By that stage, I had already switched my new diet - On average 10-15% carbs. 20-30% proteins and 60-70% fats - mainly animal fats (as in just those attached to whatever I was eating - salmon with the skin, ditto meats with the skin and fat, some olive oil and I don't eat vegetable oils.
I went in clutching Haimoto 2009, my saviour. In the meantime, I had read all of the papers he has referenced. Nothing I read contradicted my first impression, just reinforced it. By that stage I was starting to learn that there were thousands of people implementing these ideas all over the world. In fact, the only person it seemed to be complete news to, was my doctor!
My blood sugar had already halved to 9 mol in 4 days.
I told my doctor, “Nope I am not taking any medications”, I will just do this....
He laughed and said: "It won't work”.
Over the months, as my numbers improved without drugs, he went from, “won't work” to, “can't sustain” to, “you are unique” to, after three years, "tell me again how exactly did you do this?".
He retired as soon as I told him...... I'm hoping not because I told him!
I said at the beginning, I am an accountant - our profession can also obfuscate, accumulate, and aggregate data that then loses its meaning to the ordinary person.
The chart on the left is, how an accountant would look at blood panels:
The start point is the mid-point of the range for each marker. If for example, all of the actual numbers on an individual’s panel were at the mid-point, then there would be no bar.
The bigger the bar the further away from this mid-point is where one's blood panel is - i.e. the unhealthier you are.
The red bars show just how far away from "mid-point " I was on my T2 diagnosis across the entire blood panel - This was very bad news.
The green bars measure how far away I was one year later. Across all measures, all markers got closer to the mid-point, so the dark green bars are smaller - This is good news.
In a few areas I did appear to get further away from the mid-point but that is actually reflective of the fact that good is supposed to be low, or indeed high not the mid-point itself and in those instances the light grey bars representing the range have been changed to light green in the correct direction. This explanation will probably elude many of the "non accountants".
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This particular chart does not measure "fasting insulin", it’s not on the panel ordered in the UK at all. Once I had started to understand a little more and indeed joined in an initiative being undertaken by the Noakes Foundation in South Africa I did get it tested. I recall getting a letter from my GP congratulating me that my fasting insulin was now in the normal range. My number was 20 Iui/Ml, the normal range in the UK was 5-25 Iui/Ml. What I knew, but my doctor apparently didn't, was the fasting insulin should be under 5. On average in the UK, it was around 12 and above 8, one should be taking a closer look because T2 diabetes was on the horizon!
It is all too easy for professionals to get caught up in complexity and to accept ranges as being normal when they aren't.
Haimoto managed to explain it in under 100 hundred words. Dr Unwin manages it with 10-minute NHS appointments.
Ameliorating the effect of a diagnosis of T2 diabetes is simple. Just cut the carbs. I say ‘simple’, not ‘easy’. It is not easy because carbs surround us everywhere, every day. That is why the general public needs to understand just how simple it is guided by enthusiastic medical professionals and educators who can help them to make better choices.
My own mantra is ‘eat MEDS* if you don't want to take med(ications)s.’
*MEDS = Meat, Eggs, Dairy, Seafood.
Cook simply, use their intrinsic fats to taste, add a vast range of above ground vegetables, spices, cream, cheeses - all tailored to what you actually like and can afford - (for example, I often eat offal), avoid ultra processed foods, grains and starches, treat fruits as deserts not as go to five a day snacks.
Dr Unwin says “Just eat foods that don't put up your blood sugars - his sugar infographics will point you to the same end result as my little mantra.
In 2009 Haimoto said this:
"Table 1 shows the list of foods that the subjects were instructed to avoid.
Staple foods:
Rice, bread, corn, spaghetti, noodle made of wheat or buckwheat, potato, sweet potato, taro and yam.
Fruits:
Pear, apple, persimmon, mikan, orange, grapefruit, peach, grape, melon, water melon, banana, pineapple and Japanese chestnut, etc...
Vegetables:
Carrot, Indian lotus, pumpkin and autumn squash.
Confectioneries
Drink:
beverages containing sugar, glucose and fructose, and milk.
Alcohol brew:
Sake, beer and wine (Distilled liquor was not restricted).
There were no other restrictions. Patients on the CRD were permitted to eat as much protein and fat as they wanted, including saturated fat.
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Since then, thousands of papers have been written debating these issues and meanwhile tens of thousands of people all over the world have followed this advice, knowingly or not. Haimoto himself was following advice that his forefathers knew. In 1912, pig farmers were writing about how to fatten pigs, eat grains and skimmed milk -Why, oh why did this become the standard healthy low-fat diet for people?
I have read hundreds of papers since Haimoto 2009 and I see no reason to doubt that very first paper.
Thank you!
To Hajime Haimoto, Tae Sasakabe, Kenji Wakai, Hiroyuki Umegaki, and an unknown Japanese lady for setting me on the right path.
To Dr Unwin for being so much better at telling the world than I am, and to Dr Schoonbee for allowing me to bring a whole host of Maltese to Zurich to start to lean how they can make a difference here too.
Amanda Atkins and Afinia supporting metabolic documentaries
Fat Fiction
The Diabetes Solution
The Diabetes Solution
Film Threat Review.
Director Isenhart dives very deep into the events in history that brought us to this point, beginning with President Eisenhower’s heart attack in office. It was an event that scared the nation and created a narrative about the dangers of fat that’s been impossible to turnaround. Worse, anyone who’s dared to challenge it has been either publicly shunned, silenced, even stripped of their credentials (in some countries).
I’m reading back my review, and yes, I’ve fallen hook, link, and sinker about what it has to say about the benefits of fat. Fat Fiction makes a convincing argument and is must-see watching no matter where you stand on the issue. It’s bold enough to question the conventional wisdom of over fifty years and does so in a smart way. It’s also not there to say, “we’re right, and you’re wrong.” If anything, it gives hope to anyone struggling with weight issues, heart problems, and life-altering diabetes. Hope is something we can use right now. And right now, I could use some bacon!
Also available for free on you tube (with adverts).
The Diabetes Solution
The Diabetes Solution
The Diabetes Solution
The diabetes community has been filled with deception for the past 50 years. The typical guidelines for managing diabetes haves ultimately caused suffering for millions of people with the disease. Follow a group of families and doctors as they present a solution to managing diabetes that could spare many patients from devastating complications in this seminal documentary about diabetes.
DIRECTED BY: John Lombardy Beckham
WRITTEN BY: John Lombardy Beckham, Bethany McKenzie
STARRING: Ryan Attar, Richard Bernstein, Ken Berry.
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Another movie, called 'First Do No Harm' starring Meryl Streep, produced and directed by Jim Abrahams in 1997, 28 years ago, covering the same issues.
Change is slow!
Check out Typoenegrit on Facebook
CANCER/EVOLUTION
The Diabetes Solution
CANCER/EVOLUTION
CANCER/EVOLUTION is an award-winning 4-part docu-series on the metabolic theory of cancer and emerging associated therapies.
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The newest hope for cancer may be one of the oldest. For over fifty years humanity has marshalled every resource in the war against cancer with little to show for it. The eye-watering amounts of money spent on research and drug development have failed to generate meaningful treatments or improve patient survival. But what if our most basic, foundational assumption about what causes cancer is wrong?
Buried for a century, the metabolic theory of cancer is overturning entrenched dogma and reshaping the future of cancer treatment.
The 5-part docuseries, CANCEREVOLUTION, explores cutting-edge discoveries based on centuries-old research. It is the story of the revolutionary scientists and practitioners committed to following scientific evidence rather than institutional dogma to find effective cancer treatments.