that first morning at sea...

Diabetes and obesity being the acute problem it is, world-wide, half the first morning of the low-carb cruise was devoted to discussions of treatment.  Doctors Keith Runyan and Eric Westman spoke on "Management of Diabetes with a Ketogenic Diet," and "HEAL Diabetes Medical and Weight Loss Clinics," respectively.  They were followed by Dr. Justin Marchiagiani with "Hormonal Imbalances and the Blood Sugar Connection," which I would say is a decidedly-related subject.  After lunch, Westman returned with "A Brief History of the Treatment of Diabetes." 

Runyan is an MD in practice, whose specialty is nephrology;  he came across very positively in my opinion.  He pointed out how problematic it is to try to manage diabetes via injected insulin, because of issues like the error rate of 50% in calculating the glucose-producing properties of one's diet, and the error rate of 30% for insulin itself!  Experience has demonstrated to him that Type Ones CANNOT satisfactorily get along on medication alone.

Conveniently, low-carbing for diabetes has been around since 1796 -- officially, that is.  Lord knows how long it was used before someone actually wrote about it....

You see, quite separate from the *problem* of high blood sugar is the ***PROBLEM*** of glucose that is life-threateningly low.  That's where relying-on-insulin leads you, on an ad-libitum-carb diet. 

The brain requires about 600 calories of energy per day, independent of bodily activity.  Outdated sources STILL insist that the brain only functions on glucose, but insisting on this only highlights the BLOODY IGNORANCE of the one who does the insisting.  In fact, 60% of the brain's energy needs CAN be supplied by ketone bodies and amino acids.  Merely 1-1.5 g/kg-body-weight of protein plus <50 g/day carb should result in enough ketosis to protect the brain from hypoglycemia.

Ketones block the body's autonomic responses to hypoglycemia -- experimentally, all the way down to 18 mg/dl -- EIGHTEEN!!!  Wooo reports her own BG values as low as 40 without symptoms of hypo, and that's "free-living" "in the real world" stuff.  A lot of things are seen in labs which don't pan out IRL.... 

And this, again, is ONLY what you get via carb-restriction:  add MCT oil -- which works in the presence of the hyperinsulinemia one often sees in Type 2s -- and sick patients can get improved cognitive function even without keto-adaptation.  Runyan reports that even non-LC doctors are getting on the bandwagon.

When his presentation is "up" on the lowcarbcruiseinfo.com site, I heartily recommend it!

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I made very few notes from Westman's talks -- I guess i'd heard most of it before.  The HEAL Clinics seem to have a very good website, so for more info you have an option to get it first-hand!

...Oh, and see the movie "Fed Up"....  ;-)

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Marchiagiani impressed me favorably, as well -- looks like I need to go check out his youtube videos!  Here's where you separate the actual SCIENCE from broscience, when it comes to the broader hormonal responses to dietary carbohydrates and blood sugar.

He stressed the extensive feedback systems our bodies use to regulate themselves -- only his own slides can describe this adequately!  One simple cascade made it to my notes, though: 

cholesterol -> pregnenolone -> progesterone or DHEA

Thyroid hormone is crucial to this process to break down cholesterol so it can cascade into the "good path" of other hormones.  "Then they all feed back into each other, back and forth," I wrote.

Stressors raise cortisol and blood sugar, and turn hormones into inactive forms.  And out-of-range blood sugar is the biggest stressor.

The thyroid system actually performs best at medium BG levels -- too high is horrible, and too low is no good, either.  NOTE:  I didn't say medium CARBOHYDRATE, I said medium BLOOD GLUCOSE.  (...and how do we moderate blood glucose, kids...?)  System performance declines with higher BG and insulin.  The inflammation that goes along with insulin resistance can cause hypothyroidism, and autoimmunity too.  Interestingly, the use of metformin results in a reduction in thyroid nodule size -- is that significant or what?

For his patients, Marchiagiani recommends not fasting if they're stressed -- it just increases cortisol production in those individuals.  For them, he suggests eating (low-carb of course) every 4-5 waking hours.

He also pointed out, as I have long hypothesized, that if your ancestry implies evolving in a colder climate, a lower-carb diet is indicated.  And continuing research is implying that the greater your toxic load, the more you should be reducing dietary carbohydrates too.

Marchiagiani cites a Volek study as a clear indication that low-carbing does not cause pathological lowering of thyroid performance.  [your authoress' interjection -- FU, Colpo!]  I've said for YEARS that the lower levels seen in LCers is a result of not NEEDING as much to process the diet, and the anti-aging camp agrees that low-normal is a superior state to be in.

He had a lot more interesting information -- i'm sure he had a hard time condensing everything he wanted to say into 45 minutes.  I liked his beachball-baseball analogy of total-levels of hormones as opposed to the free state (necessary to fit into the baseball-glove-like receptors).  I was also impressed by his offer to be a go-between to acquire lab-tests, when one's own doctor refuses to oblige.

*****
Despite my only-academic interest in the observation of blood glucose, I found a great deal in these presentations to hold my attention.  And these three speakers were only the beginning!