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2023-03-30 07:00 by Karl Denninger
in Personal Health , 651 references
[Comments enabled]  

Yes, the title of this posting may sound dramatic.

It is also likely.

CMS (Medicare and Medicaid) is one third of the entire Federal Budget.  When those programs were put into place the tax rates for Medicare were approximately equal to the percentage of GDP spent on medical care.  The medical system then embarked on a multi-decade program of felony anti-competitive practices and neither party has or will stop itso the percentage went from about 3-4% of GDP to roughly 20% today.  The tax rate did not materially change and would have to be multiplied by five to be reasonably coherent which, of course, is politically impossible.

I projected forward in the 1990s when running MCSNet that this would bankrupt the Federal Government by about 2025 and when it did Medicare and Medicaid would be unable to be funded.  The pressure this would place on the medical system since nobody would or will enforce the law means that the ratchet job on everyone will continue and get worse, ending in an effective collapse.  Whether that collapse is complete or partial does not matter if you're the one who needs it and doesn't get it; statistical numbers are all fine and well but meaningless in the example of one -- you.

I have long stated that you better not need the medical system within the next decade or so (going back to the '08 blow-up timeframe) and if you do the odds are you won't get it, thus you will be in serious trouble or dead and there's nothing you can do about it at that point. The only defense is to not need it.

Well, there are times you can't avoid needing it.  A car crash is obviously one of them, but there are more.  Nonetheless knowing when you need it and when you don't is quite important particularly when there is little supply.

But most of the time you can avoid it.  I did during Covid, for example, by being proactive and having on-hand that which I believed would help, fully aware that if they failed I was probably fucked.  They succeeded.  Someone I knew put his trust in the medical system instead of laying in supplies in advance.  He's dead and that sucks, but it was a free choice.

A few years from now it is unlikely to be a free choice as the system you think you can rely on, even if they aren't being wild-eyed crazy as they were during Covid, will not be there.  If you put your belief in it being there and its not, and needing it was avoidable, you will be dead.  You can't prevent the possibility of being run over by a car, but you can take many steps to reduce the risk of needing the medical system at all, and given what's going on in this country you're nuts if you don't, especially those steps which have little or no cost.

In my opinion you ought to have these things on-hand in any household.  They're not expensive.  Learning how to use one of them in particular will take a bit of time, but learn you should.  They can and will often provide key information -- perhaps critical information to discern between "not a big deal" and "oh crap", never mind quite possibly driving lifestyle changes that can wildly reduce the risk of "oh crap."

Let's go down the list on the what and why:

  • Thermometer.  Pick either contact is IR non-contact; doesn't matter, but intended for human use (thus the range of reading is suitable for same.)  The purpose is obvious -- determining if a person (you) has a fever and if so, how bad.

  • Pulse oximeter.  Cheap.  Buy one.  These clip on your finger and are about $20.  Unless you have COPD or similar you should be reading 97%+ all the time.  Sick, not-sick, feeling good, feeling not-so-good, same.  Readings below about 95% indicate serious trouble and if trending downward are very serious trouble.  As I pointed out several times early on during the viral outbreak if you are even in relatively crappy physical condition you have a reserve of several times your resting metabolic demand for oxygen; if you're in good cardio condition you likely have an exercise tolerance of ten or more times your resting demand.  Once your saturation starts to fall you have lost all of that so this is a lot more-serious than you may think it is.  These take seconds to read and are non-invasive.

  • Blood pressure cuff.  Automated, decent ones are under $100.  Some of the cheap Chinese ones are ok but of questionable accuracy because, well, Chinese.  Welch-Allyn makes one that's a few bucks more (~$65 or so), is more-accurate, has a better hose and connector arrangement and is not expensive.  High blood pressure typically has no symptoms until it gives you a hemorrhagic stroke which usually kills you or a heart attack which may also do so.  One reading doesn't mean much as damn near anything can spike your numbers for a few minutes to a couple of hours, but over a period of time this is a very big deal.  It used to be that every drug store and most grocery stores had one of the "sit down and insert arm" machines for zero cost but those are either disappearing or being replaced with ones that want information from you and have cameras in them.  You may be ok with that but you shouldn't be.

  • Glucose and/or ketone meter.  If you are over 65 or have a gut at any age you should have one of these.  Again, high blood glucose, unless extreme, shows no outward symptoms but over time destroys your heart, kidneys, eyes and results in serious neuropathy in the extremities along with circulation disorders that lead to amputations.  Unless you know you're diabetic prefer the one with individual wrapped strips as once you open a container within 30 days the strips are trash, and your use is intermittent.  You want to use this on an every three to six month basis to take both a fasting (before you eat anything) blood glucose level and then just before and on 30 minute intervals after a carb-heavy meal if you eat carbs.  If you are not back to your baseline levels within 2 hours you are insulin compromised no matter what the doctor tells you and thus you should be considering removing all fast carbohydrates from your diet.  Read here for more on this.  Type II diabetes can be stopped and even in many cases reversed without use of a single drug.  Failure to do so will, over time, wildly screw you metabolically and if you think you can just go on the medical roller-coaster, well, in a few years no you won't be able to unless you have hundreds of thousands of dollars of your personal money to spend on it.  If you care to monitor ketones as well (e.g. "am I really eating a ketogenic diet?") the KetoMojo meter will tell you both and it has individually-wrapped strips and thus is intermittent-use friendly to your wallet.

  • A hand-held EKG device.  This is relatively new in terms of availability at a reasonable (under $100) price.  Prefer one that does not require a cloud connection or subscription; this is extremely valuable data to insurance companies as cardiac problems are a huge marker for money, of course.  It will take you a bit of study to learn how to read it but most of these will alert you to any gross abnormality.  Be aware that they're not perfect and materially less-sensitive than a full "leads on the chest" EKG, but they do work.  With about an hour's worth of reading you can learn how to interpret the trace with reasonable accuracy.  You won't be a cardiologist but you will be able to spot many things of material concern that might otherwise have no symptoms and, if you do, then its time to talk to someone who really does know.  If you got clot-shotted, in particular, this might spot a potential electrical block that otherwise has no symptoms but can result in a no-warning thud.  You're welcome.

I do not recommend an AED in your own home especially if you live alone.  They're damned expensive (a thousand bucks plus!) and worthless if nobody is there in immediate attendance as if you get hit you won't be able to use it on yourself.  If you live with someone and are almost-always around them, and have any indication of cardiac trouble, then maybe the math works out differently on this but that's a hell of a lot of money that will only help someone else if you're the one using it.  Note that if you go into vFib while you and your SO are both in bed sleeping odds are they're waking up next to a corpse as there is typically no warning before it happens.  A person who goes into vFib when there is no defibrillator available is extremely likely to die even with prompt and well-applied CPR and if someone else doesn't immediately notice (e.g. you and/or your SO/wife/husband are asleep) your odds of survival are an effective zero.

One likely-controversial point: I do recommend a personal wearable device that can do HRV overnight.  Several of the Garmin watches can do so but not all, and the ones that can aren't the cheap options.  This data is unbelievably sensitive and can be used to identify things you don't know are trouble in your particular person; if you see an unexplained deviation it is real so put in the effort to find the cause.  For instance I have recently isolated and proved that I have a very mild allergy to peanuts.  I never knew this and it likely has been lifelong.  It doesn't produce any obvious symptoms but if I eat just one small spoonful of peanut butter a couple of hours before I go to bed it will materially harm my HRV overnight.  Eating a crap-ton of pork rinds and salsa with the same amount of time before bed, on the other hand (e.g. as a snack while watchin a movie) does nothing.  There is no way I could have isolated this otherwise.  I love peanut-butter milk stouts, as just one example -- guess who won't be drinking any more of them?

This sort of knowledge and device makes personal "challenge trials" of that kind, done in a "notch" fashion (that is, do it, don't do it then do it again and see if you get the deviation and then it goes away) very simple.  It will also show you the immediate and immutable impact of things like consuming alcohol and exactly how badly it "gets" you if you go out for a few rounds with your buds.  Finally it will warn you a solid day or more in advance if you're getting something (a virus, etc.) in that you'll see it in the data even though you didn't do anything the previous day to provoke the decline and know it.  If you're into athletic pursuits then this is obviously even better but even for those who are not, in my view this data is ridiculously useful and not obtainable in any other non-invasive way.

This sort of sub-clinical harm is likely a huge deal over time and yet there is exactly zero attention paid to it in the medical community nor will there ever be as there's no money in it.  These sorts of reactions are nasty because being sub-clinical it isn't obvious on the surface. Sub-clinical inflammation is likely responsible for a large percentage of long-term systemic damage including heart attacks, strokes and various and sundry autoimmune disorders of unknown origin or cause.  If you find these things and get them out of your life you avoid clinical exposure and the cost of it, never mind the personal debilitation.  There's absolutely no downside to that sort of knowledge and now you can obtain it with a bit of effort as the instrumentation on a personal basis is now within rational grasp.  I'd like it a lot if the price was lower but it isn't, and unlike the other things in the kit getting accurate data requires wearing the watch for a couple of weeks to get the baseline and then continuing to do so nightly, so its entirely-personal and thus you can't amortize the cost across multiple people in your household.  Garmin brought this to my Fenix 6x in August of last year and I have come to consider it a "must" personally, and well worth the money.

One very-important note: There are stand-alone devices that do this and most require some sort of subscription.  I consider these poor secondary substitutes for several reasons, with the most-serious being that they're not typically worn all the time and the subscription-style nonsense.  In short IMHO if you decide you want to try to exploit this knowledge Garmin, at present, is the go-to for doing so.

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2023-01-11 07:00 by Karl Denninger
in Personal Health , 603 references
[Comments enabled]  

You won't like either of these.

We'll deal with the first one first: Statins, with this study going back to 2018.  Yes, its not new, but where have you seen this reported?  Has your doctor talked with you about this?  Doubt it.

What does it show?  Statistically-significant elevations in ALS incidence associated with all statins.

Results: RORs for ALS were elevated for all statins, with elevations possibly stronger for lipophilic statins. RORs ranged from 9.09 (6.57-12.6) and 16.2 (9.56-27.5) for rosuvastatin and pravastatin (hydrophilic) to 17.0 (14.1-20.4), 23.0 (18.3-29.1), and 107 (68.5-167) for atorvastatin, simvastatin, and lovastatin (lipophilic), respectively. For simvastatin, an ROR of 57.1 (39.5-82.7) was separately present for motor neuron disease.

Association is not proof of causation, but that the association varied with the type of statin adds to the evidence for a causal effect.

ALS is otherwise known as Lou Gehrig's disease and is nasty.

Further there is no evidence that statins have an all-cause death benefit except in those who previously had a heart attack.

This sort of study evidence takes time to show up and the really nasty part of the equation is that most people who are given these things are told they're a lifetime prescription.  Yet not one of these is tested over a lifetime first -- so how can you possibly know if they're safe when taken that way?  You can't.

There is a huge difference between taking a drug for a period of time as an "acute" treatment for a given condition, then you stop and chronic, long-term (meaning lifetime in many cases) use. Antibiotics are an example of this, as with many other medications.  You use them because there is something wrong right now and when its no longer wrong you stop using it.  The same is true for intermittent-use medications; for example, Ivermectin is known to be extremely safe in that sort of use because it has been used for forty years on an intermittent basis to control parasitic infections, typically taken once every few months.  In this sort of use pattern four billion human doses have been administered and the serious adverse event risk has been found to occur roughly once in every 600,000 people it is given to.  To put this in perspective both aspirin and acetaminophen, which are both intermittently used by millions of Americans, have a serious adverse event risk over ten times higher that Ivermectin.

This does not mean its safe to take Ivermectin on a daily basis for life; there is in fact zero evidence that this is the case and you'd be stupid to extrapolate the intermittent-use data to imply that it is safe when you use it daily.

Aspirin was for a long time recommended for older Americans on a low-dose basis as a potential stroke and heart-attack inhibitor.  We know its safe enough to sell over the counter for intermittent, acute use (e.g. for headache or fever.)  It turns out that when used daily, on a chronic basis, even in the low-dose form the data is that it may kill you due to bleeding as often as it prevents heart attacks.

Attempting to generalize acute safety to chronic, long-term safety turned out to be a bad idea.  It took decades to find this out, by the way.  Duh.

Now we have another craze -- GLP-1 agonists, which showed up about 2009 for Type II diabetes, and particularly Tirzepatide which combines a GLP-1 agonist and a GIP, is being "fast tracked" for weight reduction.

This is bone-headed stupid for several reasons and that the FDA is even considering such use, or doctors are using it, ought to get every single one of them nuked from orbit in the general case, subject to limited exceptions.

Why?

First let's talk about how these drugs work.  GLP-1 agonists promote the pancreas' secretion of insulin and GIP inhibits apoptosis (natural cell death) in the beta cells of the pancreas and promote insulin.  The problem is that this by definition is very likely to lead to hyperinsulinemia; that is, higher than normal insulin amounts in the blood.  Insulin is not a benign substance; it is necessary for the metabolic processing of glucose however it is also inflammatory.  Systemic inflammation is extremely bad.

Most Type II diabetics, by the time their blood sugar goes out of whack, have had hyperinsulinemia for years and often decades.  Type II diabetics have a functional pancreas; they have beta cells which secrete insulin in response to glucose levels in the blood.  However, the body's cells have become resistant to the insulin and thus sugar continues to rise, insulin is secreted in larger amounts, and that larger amount brings it down as the cells take up the glucose and process it.  You have formal Type II diabetes when the pancreas can no longer secrete enough insulin to overcome this resistance and thus blood sugar rises uncontrollably.

Note that it is almost-never the case that a routine test for hyperinsulinemia is done.  You can in fact test fasting insulin.  Reality, however, is that a blood draw is not really required -- all you need to do is stand upright naked against a wall, bend only at the neck and look down; if you can't see your junk odds are extremely high your fasting insulin level is high.

This tolerance reaction is extremely common and in fact is one of the nasties that underlies many drugs of abuse.  Opiate users wind up killing themselves this way on accident all the time; as you use opiates the amount you need to get "high" or obtain pain relief goes up but the amount that depresses your respiratory function rises at a much slower rate.  Eventually the two lines cross and if you keep using the opiates you die.  This is why long-term abusers often use a stimulant (often these days meth) at the same time (this used to be called a "speedball" back when I was younger) because the meth stimulates the breathing and circulatory reflexes and thus staves off what would otherwise be a lethal overdose.  That obviously has its own problems; if you keep using once you're in that coffin corner you will kill yourself either via a mistake or cardiac destruction as a result of the stimulants you're using to avoid respiratory arrest.  See Saint Floyd for a notorious example that nobody wants to bring forward as it destroys a narrative.

If an opiate addict is jailed and forced to detox when he comes out and uses the same amount he formerly tolerated it frequently kills him immediately because that tolerance reaction partially reset itself and he didn't know that.  Daily uses of marijuana have the same thing happen if they stop for an extended period of time; what was a "heh this is a fun buzz" becomes a "you're one with the couch for four hours" dose.  Fortunately the weed doesn't kill you; it just makes you very uncomfortably stoned.

Tolerance reactions raise extremely serious concerns in any drug used on a chronic basis, and in particular drugs like this which deliberately promote higher serum levels of an inflammatory substance.  It would be reasonably expected that using these drugs on a chronic, lifetime basis is going to wildly promote all manner of trouble from said inflammation, from heart attacks and strokes to various other inflammatory issues -- including, perhaps, promotion of cancer.  Given that expected reaction the burden to prove it doesn't happen across decades is on the manufacturer and until that's proved it should be assumed that this will be the result and over those decades it will kill people.

Yes, obesity is a serious problem but it is not a disease.  It occurs because you have damaged the insulin response in your body and if you test non-diabetic overweight and obese people virtually all of them will have high insulin levels even though their blood sugar is normal.   The answer to this problem is to stop insulting your insulin pathway so that the tolerance bleeds back off.  Provided your pancreas is not already critically damage it both can and will do so but not overnight -- just as you didn't develop the problem overnight.

That can only happen one way: Stop consuming fast carbohydrates on a durable basis.

There is no solution found in the pharmacy for the problem because the problem is that you are insulting your metabolic system.

The side effects from stopping that include your pants falling off.

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2018-02-27 15:35 by Karl Denninger
in Personal Health , 426 references
[Comments enabled]  

I get asked this a lot, so here are my thoughts.

First, two disclaimers -- I'm not a doctor.  Second, I've got a lot of data, but it's all mine so it's all anecdote.  All I can back it up with is a few friends who have similar or identical gear to what I use.

So with that said, here we go.

First, alcohol (drinking alcohol now, not the non-potable versions!) are ethanol.  They are a form of carbohydrate.

But alcohol is a special carbohydrate.  Unlike the common sort in foods ethanol is preferentially metabolized -- that is, it is burned first before other carbohydrates. This is why you get drunk (instead of it "mixing" with all the other carbs and being taken up slowly, which would mean you'd have to drink on an empty stomach to get drunk at all) but at about one drink per hour, you also burn it off at the same rate no matter how much food you eat.

Like all other carbohydrates, however, ethanol also produces the same sort of boost/crash response that you get from other fast carbs, and in fact since it burns first it's arguably the fastest carb.  This is why when you're drinking you often want food and is why "bar food" is inevitably high in carb content (e.g. french fries, etc); the bar owners are not stupid and they sell what people want to buy.

There are two basic problems with drinking alcohol in any amount as it relates to a keto lifestyle.  The first is that booze inherently is anti-ketogenic, although if you keep it to one drink in a day you can remain in a ketogenic state and have that one drink, provided you are performing some amount of exercise (so as to keep glycogen stores very low.)  The problem is that the second drink, and any non-keto food you might consume due to the cravings that alcohol does produce, is almost-certainly enough to knock you out of a ketogenic state.

There used to be a book out there from the early 1900s called "The Drinking Man's Diet."  Unsurprisingly, it called for consumption of essentially zero carbohydrate; the reason is that alcohol consumption greatly potentiates weight gain if you eat carbohydrates.  Why?  Because it's metabolized first and thus the rest of the carbs you take in wind up being stored as glycogen and, if your glycogen stores fill it goes directly on your body as fat.

So that's the keto-related bad news, basically.  But unfortunately the bad news doesn't end there and it's not ketogenic-specific.

I own a Fenix 5x, which I wear basically all the time (except when doing some sort of work that might damage it, such as working on my car, and when it needs to be charged) including overnights.  It's an incredible piece of equipment which I bought mostly for its performance tracking under exercise and its mapping functionality, which is a safety feature when I am hiking in the backcountry ("never lost" as long as it can see the sky and has power.)  No, it's not a substitute for a map, compass and knowing how to do land nav, but it's convenient and, in my opinion, was well-worth the investment.

It also gives me a hell of a lot of data across my entire day.  One of the things it allows me to do is track the quality of sleep, heart-rate variation (which maps to your stress level) and resting heart rate.  And this is where the second piece piece of bad news comes from.

I can tell you from looking at that RHR and HRV (stress) level during my time sleeping on which days I have had zero alcohol intake, on which days I had one drink, on which days I had two, and on which days I had more.  The "more" doesn't matter; once you pass the second one in a day from a stress point of view you may as well get hammered.  My accuracy rate just looking at this piece of information alone is astoundingly high -- and when it's wrong, it's never wrong on the low side (that is, indicating less stress than my booze intake indicates.)

The first drink will raise my resting heart rate by a point or two and delay my systemic stress level from dropping into the lowest category by a couple of hours.  The second by two to four points and costs me half the night in terms of getting into that "resting" state from a stress point of view.  Third and beyond?  You're screwed in terms of actually getting anything that's called "rest" when you sleep.

This has profound implications if you are interested in athletic performance as well.  There's simply no way you will be well-rested and able to perform at peak capacity if you've had anything to drink for two to three days prior to the event.

This is utterly repeatable, every time, has been since I've owned this unit from the first day forward and anyone that has access to that data is going to be able to figure it out without knowing anything else about you.  A couple of friends of mine who have similar units have told me that they have identical results, and I've confirmed this as they've let me look at their data briefly and told them which days they went out to the bar.  I was right -- every time.

For this reason putting such data in the "cloud" and allowing anyone else access to it is a profoundly bad idea.  You don't need an AI to process this, just a pair of eyeballs!

It would be utterly trivial to determine your consumption of booze and "box" you from which it would then be trivial to do things like charge you more for insurance.

The above, by the way, assumes your alcohol is liquor and there are no sugars in whatever you mix it with, if anything.  Straight-up Scotch, vodka-and-(diet) tonic, etc.  Beer and wine also contains carbs that are not from the alcohol; those have to be counted too and it's almost-impossible to know what the non-booze carb content is with the exception of a handful of "light" beers that advertise it -- because unlike actual food the manufacturers don't have to tell you, and they typically don't.  When it comes to craft beer you may get away with one pint glass (or 10oz for high-gravity) of beer but you won't get away with the second in terms of ketosis.  The same issue presents itself when it comes to wine.

So if you're asking whether drinking alcohol is compatible with living a ketogenic lifestyle, the answer is "maybe."  The maybe is that if you are actively trying to lose weight then no, it isn't, and by the way, it doesn't matter what form of food intake you're using in that case because alcohol will poison all of them in terms of weight loss.  The old saying that "he has a beer belly" is not bullshit, in short.  One of the worst ways to sabotage your metabolic systems is to screw with your hunger regulation -- while it's possible to ignore that it takes an amount of willpower few possess.

If you are very studious about avoiding any sort of other carbs, except for nutrient-dense green vegetables, then you can probably remain in a ketogenic diet with one drink a day, assuming you are an average-height male.  Women have it tougher simply because on average they're smaller and alcohol is typically not "sized" in terms of the size of the drink to match body size and mass.  This means that for most women that first drink is going to be borderline.  Your odds of remaining in a ketogenic state improve if you are engaged in a material amount of vigorous exercise daily (defined as at least 15 minutes of effort in heart rate zone 4 or 5) as well.

But beyond one drink it doesn't matter if you're trying to live a keto lifestyle.  You will get knocked out of a ketogenic state with the second beer or mixed drink essentially every single time and it is likely to require 48 hours or even more to return to it.

So yeah, if you have one night a week you have a few beers and such you basically took a 7-day ketogenic state and turned it into a 3-4 day one. That's half.  If you're already where you want to be in terms of body mass and metabolic state you can get away with that once a week and probably not harm yourself all that much.

But if you do that twice in a week you can forget it.

The worse news, however, is that ketogenic or not that second drink costs you substantially in terms of impacting your overall body stress level and quality of sleep.  The third one destroys both and it will require 48-72 hours of abstinence before things are back to normal.

This, incidentally, is wildly out of kilter with what the so-called medical "experts" will tell you.  They all say that one drink a day is not harmful and may even be protective; that the second one is probably "neutral" and real serious harm starts with the third (and gets rapidly worse with increasing quantity.)

Nope.

The trivially documented disruption starts with the first drink, the second does very material damage to the quality of your rest and beyond that you may as well get rip-roaring trashed in terms of cardio and overall systemic stress.

I'm sure a far more-strict analysis is almost directly dose-dependent -- for example, the damage done to your liver.  But here I'm not focusing on the long-term chronic effects from drinking too much -- those are both well-known and basically impossible to argue with.

This is simply looking at the data in the context of consumption of "routine" amounts of alcohol if you are trying to live a healthier metabolic lifestyle.

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2016-06-18 05:00 by Karl Denninger
in Personal Health , 1435 references
[Comments enabled]  

The often-heard comments when someone says they're eating HFLC include "your kidneys will explode", "Atkins was really bad for him (Mr. Atkins)", "You'll have a heart attack", "You can't be athletic doing that; you need carbs" and more.

I would like to put some perspective on this.  Yes, this is anecdote; it's a sample size of one with no double-blind, of course -- that is, my personal experience.

Some background: Somewhat over five years ago I essentially went hard-core Atkins-induction coupled with "Couch-to-5k."  At the time I was unable to run one half mile without stopping, climbing a few sets of stairs was work, even summer lawn mowing was a strenuous exercise -- while the heat was certainly not helpful, neither was exercise tolerance.  I was "nominally healthy" in that I was not diabetic, but my body mass had risen from about 155 in High School to right around 210, plus or minus a couple.  I had several times undertaken fairly severe exercise regimes, including hour-long daily stints on a stationary recumbent bike I purchased, in an attempt to lose weight, along with a low-fat, "eat plants" diet -- without success.  I could drop 10lbs without much trouble, but no more, I was ravenously hungry all the time, and as soon as I cut back on the exercise the weight came right back on and stayed.

I'm absolutely certain that I was insulin resistant even though my blood glucose was normal -- I'd get the "hangries" if I attempted to not eat in the morning immediately on waking, and was often hungry for something by mid-afternoon after eating a carb-laden (and low-fat) lunch.  If there was a bag full of M&Ms in front of me and I had one, the entire bag would be gone within a couple of hours.  The same for a tin full of cookies.  A loaf of home-made bread (I have a bread-maker) would be lucky to make two days; the first big, thick slice would get consumed and I'd want two more an hour later.

In short despite my outward metabolic signs being ok, but being overweight (not obese) I know exactly where I was headed -- for both obesity and diabetes.  I'm sure of it.

So in early 2011 I decided I'd had enough -- that the conventional wisdom was either wrong or I was simply going to be consigned due to bad genetics to get older, fatter, and sicker.  The latter is what we have all been sold and I was determined to not simply give up.

Since that was the consensus, I saw no harm in trying something else -- after all, the odds were that I would not make it worse, at least not quickly, and when it comes to things like heart attacks and strokes they take years to develop, weeks or months.

So I went full-on, zero-carb Atkins induction, bought a pair of Nike running shoes and a Garmin 305 with a heart rate strap to track my exercise.

I'm not going to tell you that this was an easy path, at least at first.  I modified the Couch-to-5k thing (you can look it up online) in only one way -- the very last segment of each work-out I ran as hard and fast I could.  At the start this was maybe an eighth to a quarter of a mile, but it would grow to a half-mile later.  Other than that I pretty-much followed the program.

I could not run a half-mile when I started.  Not even close.

I felt like I'd been hit by a bus every.... single... day.

But I kept with it, both on the food and running.  After the first two weeks I added back green vegetables, but otherwise ate zero carbohydrate -- and that included alcohol.  Instead of three times a week I tried for five, and got up at 0500 every day to do it because living in Florida it's hot, even in May.

In the first week, five pounds disappeared.  I knew this would happen and probably be (mostly) water.  The next week and pretty-much every week thereafter, however, another one or two came off.

About two months later I ran a full 3.1 miles for the first time, without slowing to a walk or stopping.  It was not easy, but I did it, and by now it was the middle of June.

Eight months later, roughly that Thanksgiving, I was down to about 160.

I looked at the Garmin stats.  I had lost 50 lbs, which is about 175,000 calories. Running is about 120 calories a mile, according to a heart-rate adjusted GPS machine, and I had run roughly 500 miles at that point, or 60,000 calories worth.

Only one third of the body mass I lost was due to exercise.  That's a numerical fact; the rest was lost due to changing what I ate.

I slowly lost about another 5 lbs; my body weight now fluctuates around 155, +/- 5, assuming I'm reasonably good.

And there it has stayed for the last five years -- whether I'm training for a half-marathon, the Wicked Triple (three races in two days of close to a marathon distance in total), hiking part of the AT, sitting on my ass enjoying a vacation or whatever else I might be doing.  My exertion levels have literally been all over the map, yet my body mass has not.

What has remained constant, more or less, is my adherence to the consumption of food things (and not consuming others!) that I have laid out many times -- you can read that list right here.

Now here's what's changed long-term when it comes to my person and my health that I haven't talked about much:

  • Since I was a child I have had horrid problems with seasonal allergies to the point of being nearly useless twice a year for a month or so.  No amount of medication, OTC or prescription, has ever successfully controlled this completely.  Benedryl works but knocks me flat on my ass, and anything containing pseudoephedrine makes me feel extremely uncomfortable -- I'm one of the people who just can't use any decongestant containing that substance.  I was basically forced to remain indoors, in an air-conditioned space, for two months out of the year and maintain a high-quality pollen filter in my car's airhandler -- or else.  I also avoided travel to woodsy and other flowery areas during the times they were in bloom for obvious reasons.  Slowly, over the last couple of years, my seasonal allergies irrespective of where I am in the country have almost completely disappeared.  They're not completely gone; I still suffer from some congestion for short periods of time, but it's much better than it was.  Last spring I hiked a piece of the AT through the spring bloom, complete with thousands of bees pollinating the flowers, and had exactly zero trouble.  Five years ago that would have been unthinkable.  This appears to be correlated with....

  • My general inflammation level has, I believe, dropped quite a bit.  I had always had "on and off" acne problems, even as an adult.  As a teen it was bad, but it never went completely away -- until I got rid of the carbs.  The same is true of skin issues; I always had them on and off, especially in the winter when the air is dry.  Again, completely gone the first winter and they have stayed gone since.  Gee, I wonder what's going on in my coronary arteries?  Betcha it's not bad things but no, I'm not paying a couple of grand to get CT+contrast scanned to find out for sure.  (The one exception: perfumes in laundry detergents will still "get" me, so I have to watch out for that.)
     
  • I have no adverse blood glucose reaction to sugar intake.  I have, a couple of times in the last year, "challenged" my body with heavy sugar intake just to see what happens; typically with a large dose of milk chocolate or heavily sugar-laden confections like donuts.  I've not been able to drive my blood glucose over 110 with such a challenge despite intentionally trying.  I don't know if I could actually drive my blood sugar to anywhere near 140 today (the upper boundary of what they call the "normal" reaction to such a test) if I literally sat and ate a bag of sugar.  Note that while I was never diabetic I'm very sure my metabolism was compromised.  For those who wonder if your metabolic systems can heal over time if you stop insulting them, the answer appears to be "Yes."

  • I don't like sugar any more.  Things with a lot of sugar in them taste like crap.  Raw white sugar now has a smell to it that I associate with being "medicinal" and is not at all pleasant.  It sort of smells like poison, in fact -- hmmmm.... maybe it is?

  • I have no "hangries" -- ever -- or carb-cravings.  I often have no desire to eat anything before roughly lunchtime; I'll get up in the morning and am simply not hungry.  This means that if I eat something around lunch, and then around dinner, I'm effectively fasting 18 hours out of every day.  It's not because I'm trying, it's because I'm not hungry.

  • If I do work out a lot my appetite goes up.  If I don't it goes down.  I don't have to think about it, count calories, make efforts to restrict my consumption of food or anything like that.  It's simply this: If I'm hungry I eat.  If I'm not I don't.  Oh, and since I'm not gorging myself on hangries my capacity for food has shrunk.  Yes, it appears my stomach is smaller, in that I get full faster -- and it empties slower too.  An interesting observation that I cannot correlate with fact, but I sure can with how I feel if I try to stuff myself for some reason.

  • My exercise tolerance has gone up massively.  The other day I worked on wrecking out part of my gazebo floor (it needs replaced) which involved using a Wonder Bar, saw and moving sand (via shovel and yard cart) that had accumulated under them and then mowed most of the back yard -- in 90ish degree weather with 85%+ humidity.  It was hotter than Hell, but other than needing to stop and get a drink a couple of times it wasn't all that bad.  I would have heat-stroked out trying this a few years ago -- literally.  Likewise I might go run a 5k tonight, and while the sun will be down it won't be any cooler.  Yes, it will be hotter than hell, but I'm not concerned about not being able to do it.  This I attribute to the exercise, not the diet.  But, with an extra 50lbs I suspect I wouldn't be able to move my additional mass irrespective of my cardio condition anywhere near as well as I can today.

  • I am far faster running now than I ever was -- including in High School!  I was never able to break the 9 minute mile barrier on a 3 mile run, with my "typical" time being around 30 minutes.  My PR now is 7:00 flat on a timed 5k race and 7:49 on a half-marathon.  This isn't a singular result either; my kid, who ran one season with the HS cross-country team, has half-way adopted my way of eating over the last six months -- and not only has her appearance improved she has also taken more than two minutes a mile from her time, breaking the 10 minute/mile threshold for the first time in the last couple of weeks.  Don't tell me you can't perform athletically on a low-carb diet -- that's a damned lie.

I'm not going to tell you this was all easy, because it wasn't up front.  Yes, carb-cravings are real.  A week or so back while in a group having a conversation that turned to food I remarked that I do not, as a rule, eat carbs -- my carb intake is for the most part beer, and only a couple a day maximum.  A nurse who was there proceeded to say that "Atkins causes kidney disease" and further that she "has cravings for carbs and thus needs them."  Both are false; first, Atkins is high fat, not high protein.  It is true that high protein diets can cause kidney problems but that's not Atkins; that's doing it wrong!  Second, meth causes cravings too, but that doesn't mean you need meth -- it means you're addicted to it!  Carbs are the same deal; when challenged as to the specific nutrients that you need that are in carbs, of course, she had no answer.  That would be because there aren't any; the amount of carbohydrate you actually require in your diet is zero.  I gave up; oh, she was complaining about having big snoring problems too (gee, I wondered, if you lost some weight what might happen to that........) This, however, is illustrative of the attitude of many in the so-called "health business"; their 4 hours of class at some point was not only insufficient most of what was in there is flat out wrong and even when taking this path might help alleviate a person problem they're experiencing they won't try it!

Here's my view, more than five years into this: I've seen exactly zero bad effects from adopting this lifestyle, and multiple good ones.  My indicators of metabolic health have improved, my exercise tolerance is up massively, I am more able to perform athletically today than I was when I was 17 despite being three times as old, I have zero glucose tolerance trouble evident when challenged, I am never "hangry", I do not crave carbs and in fact find things with sugar in them "too" sweet yet I count no calories or make other conscious attempt to control my food intake and my body mass is approximately what it was 35 years ago and hasn't moved more than a few pounds in either direction for the last five years.  The only exception was when I was in a relationship, eating far too many carbs (and knew it) and five more pounds went on -- literally as soon as I cut that crap out they disappeared within a couple of weeks.

Why would I change what I'm doing now, when for the last five years it has worked -- effortlessly -- to not only halt what was an obvious and visible (albeit slow) decrease my personal vitality and health that many would simply attribute to old age, but almost-completely reversed it -- and in many cases my health and physical abilities now exceed those of my teen years!

Yes, I'm a data set of one.

Now tell me why would you not run your own experiment.

I'm all ears.

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How does this sort of tripe wind up in print?

Aamodt is a neuroscientist, book author and former editor of a leading brain research journal. She also has become a prominent evangelist of the message that traditional diets just don't work and often leave the dieter worse off than before. And she's an enthusiastic proponent of mindful eating.

"I define it as eating with attention and joy, without judgment," Aamodt said in an interview. "That includes attention to hunger and fullness, to the experience of eating and to its effects on our bodies."

Riiiight.

Look folks, there are people who have a mental disorder when it comes to food.  I accept this, because it is trivially shown to be true.  But the vast majority of people who are overweight are not sick in the head or suffering from some psychosis -- they've been actively misled as to what's going on and the media spurs this with its crap "reporting" such as this article.

Likewise, the "energy balance" folks (all of whom like to wag their finger and scold) are correct but intentionally misleading.  That is, it is absolutely true that since a pound of body mass is roughly 3000-3500 calories (there is some debate on exactly what the number is but this is close enough; within 20%) if you wish to lose weight you must consume fewer calories than your body burns.

There's no escaping that; it's math.  Isn't it funny, however, that these people never bother to continue their mathematical exercise?  We'll get to why not in a minute, so hold that thought.

There is, unfortunately, also no escaping the fact that running, one of the highest calorie-consuming exercises, only burns about 100-120 calories a mile -- more if you're very heavy (it takes more energy to move your fat ass) and less if you're not, but again, we're talking about a 20% tolerance here and for the most part the figure is about the same irrespective of other factors.

This, by the way, means that you must run approximately a marathon to lose a pound!

No Mildred, you cannot outrun your fork and anyone who tells you otherwise is completely full of crap.

Yes, we have an obesity epidemic; fully 40% of US women are obese along with 35% of men -- and even worse, one in five adolescents!  This is a ridiculous percentage and what's really awful is that those who are in this position are setting themselves up for utterly horrible, slow and painful ways to die -- first through amputations, then blindness and kidney disease, and finally heart attack and stroke, all after decades of avoidable suffering and restricted physical capability.

It seems that every couple of years someone else comes along with yet another crackpot theory on why it is that people get and stay fat -- and then both get sick and die as a result.  They all keep trying to make the case that it's not your fault in some form or fashion, using words like "easy" to describe their particular prescriptive answer, knowing full well that this sells books.

After all, if you told people it was their fault or would be hard how many of them would pay you for the book -- the speech -- or the "counseling"?

But all these theories are just that -- theories, and IMHO they're all full of crap when it comes to long-term success.

Here are some facts for you and they are trivially proved through nothing more than casual observation of the world around you and arithmetic you learned in the first and second grades:

  • Every organism in the animal kingdom has a regulatory mechanism in its body that is autonomous for controlling how much food said organism takes in.  Absent that since "food" generally tastes good to said organism all animals would continually fill their stomachs to their maximum capacity as often as possible, eschewing virtually anything else other than sex, until they all died of obesity-related disease.  Clearly this does not happen "in the wild" but it sure does when a creature's "natural" diet is disrupted.  Witness all the "fat cats" that eat packaged kibble, then compare the nutrients in said kibble with that in a mouse or bird. The prosecution rests, your (dis)Honor.

  • Since it requires 3,300 calories to gain or lose a pound as a human and there are 365 days in a year in order to regulate your body size within one pound per year over time you must manage to control your caloric intake and expenditure within 10 calories per day.  For some perspective that is less than 1/10th of an ounce of potato chips!  If you wish to count them accurately use Pringles (all chips the same size and mass) and you will find that to control your body mass that accurately through voluntary action would require that you keep your consumption accurate to within one potato chip daily.  Certainly you cannot do this irrespective of the form and type of food you consume through "mindful", that is, volitional conduct.  The accuracy required simply cannot be met.

  • Remember, however, that there are a lot of things that go on in your body that require maintenance at this sort of accuracy and none of them are voluntary.  Your blood pressure, glucose level, blood pH, uric acid, water content, potassium level, dissolved CO2 and oxygen saturation are just a few examples of literally hundreds.  Any of these parameters that go materially out of "normal" range will cause serious disease and in many cases instant death.  Yet your body knows how to regulate all of them, as does every other animal's body on the planet, and all of that regulation in every organism that is alive happens without a scintilla of conscious thought.

So what's actually going on?

Don't ask NBC news; they claim nobody knows:

"Numerous foundations, industries, professional societies, and governmental agencies have provided hundreds of millions of dollars in funding to support basic science research in obesity, clinical trials and observational studies, development of new drugs and devices, and hospital and community programs to help stem the tide of the obesity epidemic," the journal's editors, Dr. Jody Zylke and Dr. Howard Bauchner, wrote in a commentary.

"The obesity epidemic in the United States is now 3 decades old, and huge investments have been made in research, clinical care, and development of various programs to counteract obesity. However, few data suggest the epidemic is diminishing," they added.

Did you all flunk basic organic chem, then biochem and simply ignore the monstrous body of evidence that has been accumulated on this problem?

There is one basic fact that has to be dealt with by anyone propounding on our obesity epidemic: 

Your body knows how to regulate its caloric intake in light of highly-variable energy expenditure and do so within 10 calories a day.  If it did not the species Homo Sapiens would have gone extinct centuries ago just as would any other species that could not regulate its caloric intake.

Therefore the question must be this and only this:

Why is that regulatory system not working, can a fat person restore it to normal function, and if so how?

I believe we know the answer to that question but admitting it means admitting that the medical and "nutrition" folks have been lying to overweight people for decades and, in fact, they know damn well they've been lying which means they should all be in prison for the outrageous harms they have inflicted on millions of Americans.

Let's start with history.  Homo Sapiens (that is, our specific species) has been on this planet for about 200,000 years.  Our direct lineage in that regard is the matter of some dispute, but what is not in dispute is that until about 12,000 years ago we had no industrial mode of food production whatsoever.  That is, for better than 90% of the species' time on this planet we ate only that which we could obtain without processing, other than perhaps rudimentary cooking.

The epidemic of heart disease, obesity and diabetes is a 20th century+ phenomena.  It therefore must be traced to something (or a group of somethings) that happened in that time frame.  Ancel Keys claimed it was dietary saturated fat that led to heart attacks and strokes.  He cherry-picked his data, however, which made his advocacy not a mistake but a lie, and a fairly easy one to prove too.

So would anyone care to guess where it began?

I'll help you. It began right here with a dramatic increase in use of a very dangerous substance.

About 20-30 years following that ramp in cigarette consumption, guess what happened?  Lots of heart attacks and strokes.  Do you think this was a function of "fat in the diet" or do you think this had something to do with per-capita cigarette consumption going from ~200 in 1912 to twenty times that rate by 1959?  When you go from an average of less than one cigarette a day per-person to close to a full pack a day what do you think is going to happen to heart disease and stroke rates, with about a 20 year lag?

That's exactly what did happen.  Duh.

Then there's Crisco and other related trans-fats.  They came on the market in the early 1900s too and were in fact sold as healthier than animal fats.  But we now know that transfats greatly increase the risk of heart disease, while the association with saturated animal fats in fact runs the other way -- among European diets the highest in saturated fat (the Mediterranean nations) have the lowest cardiovascular disease rates. 

Between smoking and transfats is the causal chain clear yet or do I need a bigger clue-by-4?

Now let's look at obesity, which began to spike in the 1980s.

Again, what changed?

Simple: The US Government played hell with its "war on fat" predicated on the lie told by Keys (among others) and told people to cut it out of their diets.  But there are only three foods at a macro level -- fats, carbohydrates and proteins.  If you remove fat from the diet you must increase one or both of the others.

What got increased?  Carbohydrates -- specifically, cheap, fast and highly-processed carbohydrates.

And what do we know about carbohydrates, especially fast, processed carbohydrates such as grains (e.g. breads, pastas, etc), sugars and similar?  They all produce a large insulin response in the body.

Oh, and if that's not enough carbohydrate consumption also increases systemic inflammation and "bad" cholesterol, which prompts cholesterol in the body, a necessary component of our metabolic system, to perform the job it is present to do -- that is, to encapsulate and attempt to repair said inflammation.  Blaming cholesterol for heart attacks (and trying to reduce it through chemicals) is like blaming it for the inflamed finger you have after sticking yourself with a thorn -- rather than removing the thorn!

Finally, with few exceptions these "foods" have only existed in our diet for the last few hundred to few thousand years -- an inconsequential period of time on the evolutionary time scale.

In other words there is no evidence that our bodies know how to process these carbohydrates without harm because we did not evolve in their presence and thus our genetic coding was not selected through evolution to favor said energy sources.  The same is true for vegetable-based oils (PUFAs), none of which have been ingested in material quantity by humans for more than 100 years.

You would have to eat a full bushel of corn to get a tablespoon of corn oil and utterly nobody would (ever) eat a bowl of cotton seeds!

Now let's look at what we know to be fact in the context of body mass regulation.

Hunger (the desire to eat) is largely mediated by leptin and the hypothalamus, a small structure in the brain.  This structure is responsible for regulating not only hunger but also body temperature, sleep, and thirst.  In short some of the most-essential regulatory functions are directly controlled by this part of the brain and still more are via other structures that it interacts with, mostly via and through hormones.  This has been known since modern medicine has existed.

Now here's the nasty piece of the puzzle nobody wants to talk about, but which I believe is key to the entire obesity issue:

Insulin is a leptin antagonist.

That is, quite simply:

The higher your insulin level the less active leptin is in signaling satiety.

Therefore insulin resistance is in fact a severe problem, even when it occurs at a level that is sub-clinical and does not result in an increased blood glucose level as long the body is able to produce enough insulin, and your cells are still able to respond, to hold blood glucose within normal limits.

The harm is due to the fact that irrespective of your ability to maintain a normal blood sugar that elevated insulin level still results, in every case, in a desire to eat more food.

That is the condition of an elevated insulin level tips the balance of the body's signalling and thus makes unconscious control of caloric intake within the required tolerance, given access to food in excess of metabolic requirements, virtually impossible.

This then leaves you with only voluntary caloric restriction (e.g. "dieting") as an option which we know you cannot maintain over the long term as the precision required cannot be met through conscious control.

Worse, the divergence between needs and desires is all in one direction -- overeating and if your "diet" is a low-fat one where the substitution is made with carbohydrates you make your desire to overeat worse.

This is why when you cease dieting you almost-invariably gain all the weight back plus more -- your "dieting" has in fact done more damage to the metabolic systems that control your desire to eat!

Again, that insulin is a leptin antagonist is not a theory it is a biochemical fact.

The only means by which one can resolve the problem at a biochemical level is to remove the leptin antagonist.

Achieving that requires lowering insulin levels, and that can only be safely done (without skyrocketing your blood glucose) by restricting carbohydrate intake, especially rapid-acting carbs such as sugars, grains and starches.

It is not a coincidence that this is a corrective action in that it coincides with removing "foods" from your diet that your body was never designed to process and in fact at no time in our evolutionary history did such "foods" exist.  Those who make claims to the contrary that the intake of such "foods" in any quantity whatsoever are "safe" have the burden of proof to show how the body can handle such intake without any of the normal biochemical processes going out of the normal range.

The body of evidence found in the form of rampant obesity and insulin resistance, all of which exactly correlates with the "war on fat" by medical "authorities" and substitution of fast-acting carbohydrates in its place, strongly suggests that these foods are not safe and cannot be made safe; they can only be avoided or the consequences of consuming them accepted exactly as the correlation with smoking and transfasts correlated exactly with the rise in heart disease with the expected 20-30 year lag!

"Mindful eating" will not change your insulin levels nor improve your body's leptin signalling.

Getting the pasta, potatoes, rice, sugars and grains out of your diet, on the other hand, will. If you want the full list read this article.

As a "side effect" of following same, if you actually do it, I predict that your pants will fall off.

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