After years of attempting to educate the smug on various glaring truths, I’ve arrived at the position: “It’s not my job to make you smarter, that’s your job.” Then, I let nature sort things out.
The gauntlet has been thrown!
NelleG
(Bacon for the Win)
#8
can’t wait to see how this plays out. Hoping you educate the good Doc!
Fiorella
#9
Michelle,
I’m delighted to see that you are taking a positive attitude towards all this. And the doctor is in a great position to use this new knowledge to be a more effective doctor and save more lives. Your effort in this is quite remarkable. You are not being militant or egotistical about the subject, as in to win the argument, but instead you are approaching it with a positive “show me the science” perspective. Great job. How can he not look at the studies now?
Oh yeah…I hope the relationship continues to blossom. How charming 
valdivia.marc
(Marc)
#10
Sorry, I was away from my email yesterday afternoon…
This isn’t so much about the benefits of Keto, such much as the negative impact of a high sugar diet (opposite of Keto) to heart disease. This appeared in JAMA Internal medicine a little bit ago:
From the article:
The NEJM (New England Journal of Medicine) review served the sugar industry’s interests by arguing that epidemiologic, animal,and mechanistic studies associating sucrose with CHD (coronary heat disease) were limited, implying they should not be included in an evidentiary assessment of the CHD risks of sucrose.
I need to organize these articles…
richard
(Richard Morris)
#11
Good. Neither do I. Except when I am the “1”, and I find those experiments to be unusually compelling
He’d have to define what he thinks T2D is .
The standard definition is glycostasis. We diagnose pre-diabetes when HbA1c goes above 5.7%, and T2DM once HBA1c goes over 7.5 for subsequent quarterly draws.
My HbA1c has been 5.2% for 3 years, it was 11.2%. By that criteria I am not type 2 diabetic. But that really is a symptomatic treatment. He is welcome to dismiss my anecdote - but he has to first understand the mechanism it observes.
Diabetes (all kinds) is the inability to maintain glucose in a safe range by lowering high glucose. Diabetics have a broken homeostatic regulator (Insulin resistance or Auto-immune insulin insufficiency). However all humans have a functional homeostatic regulator that raises glucose (by making it in the liver) when it goes too low. All one has to do, to switch from the broken mechanism to the functioning one - is to inhibit dietary sugar or starch and the liver will maintain serum glucose in a safe range.
It’s a hack. One that gives diabetics tight glucose control. But to a diabetic a symptomatic treatment that lowers glucose is relevant. Every 1% decrease in HbA1c, causes a 37% decrease in risk of microvascular complications of diabetes ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC27454/ ) . So we can have a population of diabetics who have no symptoms of diabetes, and normoglycemia.
… or our health systems can succumb to the tsunami of type 2 diabetes on the horizon ( https://www.ncbi.nlm.nih.gov/pubmed/27197309 ).
As for a permanent reversal of T2DM, that will happen once the ectopic fat depositions in the pancreas are drawn down thanks to the drop in circulating triglycerides ( https://www.ncbi.nlm.nih.gov/pubmed/21656330 ).
LouiseReynolds
(Louise )
#13
The UK public health collaboration has gathered 54 studies which compares the low fat to low carb diets. It is a fantastic resource: https://phcuk.org/about/ as it collates a range of studies. That should keep him busy!
MKChitown
(Michelle)
#14
Well, here’s his lame response. And for background, he eats everything he wants, with no care in the world. He never gains a pound. The man eats cereal at breakfast… kills me. 
He doesn’t believe that processed carbs are good on any diet (but yes, he eats them anyway).
Pasted his response below with a few clarifiers. I told him I would just show him more science.
“I didn’t realize that you had diabetes, obesity and/or a fatty liver. All of these articles lack any clinically valid endpoints (mortality benefit, disease incidence, etc), particularly in otherwise healthy individuals. Decreasing carb intake makes sense in those with insulin issues (obese, diabetics,…) but otherwise there is no evidence presented that demonstrates an advantage over any of the many other diets out there. In fact for purely health reasons, Jennifer’s vegan lifestyle (Jennifer is my vegan friend) has stronger evidence for health benefits for the general population (as does the multitude of other healthy diets). I did find this last line from the neuroprotective article abstract ironic: As the underlying mechanisms become better understood, it will be possible to develop alternative strategies that produce similar or even improved therapeutic effects without the need for exposure to an unpalatable and unhealthy, high-fat diet. Yes, listen to the science!”
snarky boyfriend…
Groversaurus
(David)
#15
Unpalatable? Really? Have you taken a look at the recipes pages on here?
Unhealthy? Where’s the science to back that up?
MKChitown
(Michelle)
#16
IKR??? that was from this study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2367001/
I’m wondering if it was from one of those drinks they used for epileptic patients and not real “keto” as it is today.
carolT
#18
Wait, I thought he said he didn’t believe in it for T2D? So now he does?
He’s moving the goalposts on you (us)!
[Would be interesting to see his or yours fasting insulin levels, too. No need to be a “diagnosed” diabetic.]
Kirkor
#19
Even after he’s done all the reading (but it seems from that initial response that he’s already definitely made up his mind, and it’s kind of pointless to try to “convince” him at this point), you could do what I do when I just want to quickly explain to people why I avoid gluten even though I’m not Celiac — it’s a form of Pascal’s wager, and I’m just hedging.
MKChitown
(Michelle)
#20
Yes, I’m going to talk to him about his obtuse response. I did tell him that I’m doing Keto for disease prevention and keep telling him the perils of sugar. He knows, but won’t budge off his stance that cutting out one whole food group (carbs) is beneficial in the long run. I’m still going to throw more science at him and also keep asking for his support in my keto journey.
djindy
#21
It seems like part of the problem for his response has to do with citing T2D to begin with, and the fact that a lot of people here are familiar with T2D research. He didn’t seem to ask for anything about “normal, healthy people” in the beginning (and we have to define those terms anyway), so research wasn’t given on that.
On the other hand, there is a lot of research on that kind of group, or really on elite athletes. As I understand, that was the primary group Drs. Phinney and Volek were working with (particularly with endurance athletes) for much of their research (maybe they still do), and I believe that’s also Tim Noakes main field. I believe they show the benefits for that group in their improved endurance performance (setting records for super-marathons, etc.).
Of course, it sounds like once you present their information, he might just say, “but you aren’t a super endurance runner either”.
The research otherwise may be out there for exactly what is sought, but I’ll put things this way: the reason I started a nutritional ketogenic diet was that the research convinced me it was not likely to do any harm, at any rate, and it appeared to be the easiest and most enjoyable way to avoid things that research convinced me would do harm (sugar in the forms of sucrose and fructose specifically). It just appeared to be a practical choice, even if there were alternative methods (and indeed, I’m still open to the idea that alternative, drastically different methods are equally or even more effective, at least for certain populations).
On the vegan note though, when I looked into that research, they claimed nearly identical results, but had a hell of a lot more doubtful evidence and less convincing arguments in their favor. But, hey, maybe they work to certain degrees too? There does seem to be indications that the Standard American Diet at least is simply the worst route, and switching to nearly anything else is better.
BillJay
#22
Nora Gedgaudas addresses the appearance that vegans seem to do better, but it is only in the short term and appears to be related to the things they eliminate from their diet, and in the end so many vegans abandon that lifestyle because of all the problems it creates after months or years through deficiencies.
Lierre Keith is another former vegan who wrote the book, “The Vegetarian Myth” and explains how she eventually abandoned it because of declining health.
djindy
#23
Indeed, I’ve heard similar stories, though I’ve also heard from some that have maintained it in supposedly good health for decades.
One of the sources I like for advice related to nutritional ketosis and other matters had a similar story though (Primal Edge Health), where the couple had gone vegan (maybe raw vegan) for many years, and were kinda fine, but eventually changed to a ketogenic diet after their very young daughter developed clear deficiencies (teeth chipping easily at 2 years old). They’ll tell you they still don’t recommend a nutritional ketogenic diet for everyone they consult, and can explain some of the benefits that do exist with vegan diets (with caveats which make them not recommend it in general), but a nutritional ketogenic diet seems pretty clearly good for a majority of people (adults anyway, healthy children may have slightly different needs), until some better evidence and understanding comes along.
trekkin
(Jeff)
#24
You can eat carbs again, just follow Dr Ted Naiman’s rules. There are three times that you can eat carbs:
-before exercise
-during exercise
-after exercise
mcebis
(mcebis)
#25
Tell him this story. When I met my wife she was low carb. I laughed and said all the things he probably said. Ten years later after a low low fat diet with lean meat and healthy fruit and veg I have type 2 diabetes and high CVD risk. 3 months low carb and my diabetes reverses and CVD health normalise. A1C drops from 9.0 to 6.0% and off all medications. My doc said only one other patient did that in his 40 years!
Then get him to watch this video with you from 12 Feb. Salim Yusuf is the President of the World Heart Federation.
Then if he still doesn’t believe you ask him to talk to me!
richard
(Richard Morris)
#26
I would add to that … If you have low fasting insulin.
If you are producing non glucose stimulated insulin secretion - and there are plenty of us with high basal insulin who exercise - better to make that glucose yourself slowly and drag insulin out of circulation to replete glycogen instead of eating it to quickly fill up your glycogen.