## How to tell if you are burning fat (Reposted from Aug 2016)

If you are on Intermittent Fasting you are burning fat. The same chart from before shows why.

Carbs pass through quickly, Protein less intense but longer and Fat even longer. But what is the significance of the vertical (height) of the curve? Let’s add another line to the graph to try and explain.

What is missing from the chart is scale on the time axis. The red line shows the energy needs of your body. If your energy input is greater than you energy needs then the body stores that energy. If your energy input is less than your body needs the body releases that energy.

In the chart above calories consumed as carbohydrates are consumed quickly but get stored in the body since they exceed the need of the body for energy. Protein is the same, but much less. Fat is below the curve. This is why the Low Carb High Fat diet works so well.

Dr Fung describes the means of storage as being in one of two compartments. There’s a short term storage (the refrigerator) andd a deeper term storage (the basement freezer). The body can more easily access the short term storage. To move from the shorter term to the longer term requires fasting.

This points out what’s the problem is with just Low Carb High Fat as a means of dieting. If you don’t do intermittent fasting you are only getting the benefit of the dinner to breakfast fast.

If you ate breakfast at 8 AM, lunch at noon and dinner at 6 PM you are keeping the energy level up with food you eat for 10 hours of the 24 hours. Worst than that the 10 hours is extended by the time if takes to digest the food from dinner. If it was a largely carb meal then it might be a few hours until you go to consuming what you stored in excess during the day. Your fasting might only be 8 hours and you spend most of that time working off the day’s excess.

Is there a simple mathematical model for this? Should be easy enough to figure out one and then calibrate it for a particular person. Two of the curves are parabolic or could be simulated with a sine wave.

## Intermittent Fasting and Type of Diet (Reposted from Aug 12, 2016)

I think Dr Fung is often misunderstood. He appears on a lot of youtube videos with Low Carb High Fat (LCHF) diet folks. This has led people to believe that he is a backer of LCHF. From what I see he does support LCHF as a safe way of dieting but his actual advice is more nuanced than that.

Dr Fung’s position seems to be that the main point is to get to where your body is burning fat and they way he gets people there is to use Intermittent Fasting. To his way of thinking the type of diet matters much less than the Intermittent Fasting.

That doesn’t mean eat anything you want. He clearly says (How to Reverse Type 2 Diabetes, The Quick Start Guide):

The first step is to eliminate all sugar and refined starches from your diet. Sugar has no nutritional value and can therefore be eliminated. Starches are simply long chains of sugars. Highly refined starches such as flour or white rice are quickly broken down by digestion into glucose.

As long as the diet eliminates simple sugar and refined starches things are good.

Intermittent fasting allows time for the body to move from processing the last meal and into consuming stored fat from the body. Yesterday I did a 20/4 fast. I ate dinner at 5 PM and drank my last beer by 9 PM.

## Status Aug 12, 2016 (Reprinted)

I had some good news this morning when I stepped onto the scale. My weight had dropped another 5 lbs. 10 lbs in 2 days. Looks like a switch got thrown to get rid of water weight. Plus, it’s been hot and humid here.

My insulin use was way down, too. Two days ago my insulin use was 42.0 and yesterday my insulin use was 29.2. My waking blood sugar was up a bit at 132 and it bounced up to 140 by a couple of hours later but that’s not abnormal for me.

My meal yesterday was satisfying. In fact, I ate until I felt sick of eating. Sick to my stomach of eating.  My total calorie count was too low at 1146 cals. I tried hard to eat Lower Carb and Higher Fat but only got to (% cals from source)

Carbs 11.6%
Protein 22.6%
Fat 42.3%
Alcohol 23.5%

I had less Craft beer than the day before (2 vs 3). However I did feel the effects a lot more than the day before. I attribute this to having less carbs to flatten out the response to the beer.

Looking at the science supporting Intermittent Fasting (IF) as it relates to Insulin Resistance/Sensitivity. Here’s  a study which has great information (J Appl Physiol 99: 2128 –2136, 2005. Effect of intermittent fasting and refeeding on insulin action in healthy men. Nils Halberg, Morten Henriksen, Nathalie So¨derhamn, Bente Stallknecht, Thorkil Ploug, Peter Schjerling, and Flemming Dela). They formed the study on:

… eight healthy young men [25.0 ± 0.1 yr (mean ± SE); body mass index: 25.7 ± 0.4 kg/m2] by subjecting them to intermittent fasting every second day for 20 h for 15 days…

What happened to their body weight? The paper continues…

Subjects maintained body weight (86.4 ± 2.3 kg; coefficient of variation: 0.8 ± 0.1%).

So on an every other day 20/4 fast over 2 weeks these eight healthy men did not lose weight. Not a big surprise there. Not a great diet for healthy young men to lose weight on. (Looking closer at the chart shows that they lost a couple of pounds.)

What were the results for Insulin Sensitivity? This is where it gets good.

Insulin-mediated whole body glucose uptake rates increased from 6.3 ± 0.6 to 7.3 ± 0.3 mg·kg−1·min−1 (P = 0.03), and insulin-induced inhibition of adipose tissue lipolysis was more prominent after than before the intervention (P = 0.05).

I am not a scientist by any stretch of the mind, but I think the phrase “Insulin-mediated whole body glucose uptake rates increased from 6.3 ± 0.6 to 7.3 ± 0.3 mg·kg−1·min−1 (P = 0.03″ means they got better at using glucose, ie, their cells became more glucose tolerant. That’s the goal we are after for T2D like myself.

Seems like a change in 2 weeks of the glucose uptake rate from 6.3 to 7.3 is a significant response. When I do the math, that’s a 15% increase. And all these guys did was skip breakfast and lunch every other day.

The ADA site has an interesting study listed. The conclusions state:

No association was observed between glycemic index and SI, fasting insulin, AIR, disposition index, BMI, or waist circumference after adjustment for demographic characteristics or family history of diabetes, energy expenditure, and smoking.

This is a bit hard to accept but I have to question the results. How do they adjust for a family history of diabetes? I get the other categories but how does the American Diabetes Association (ADA) adjust for diabetes? Isn’t this what they are supposed to be figuring out?

Associations observed for digestible carbohydrates and glycemic load, respectively, with SI, insulin secretion, and adiposity (adjusted for demographics and main confounders) were entirely explained by energy intake.

This is true at least in part. The LCHF diet is most just LC and not so much HF. It’s easy to eat meats and miss the high fat sources. The end result of cutting out carbs is a lower energy intake than not dieting. Lower energy intake leads to lower body weights.

So this finding does in fact support a LC diet. It’s easier than counting calories.

Here’s the next interesting point:

In contrast, fiber was associated positively with SI and disposition index and inversely with fasting insulin, BMI, and waist circumference but not with AIR.

Fiber continues to look to be a good thing but if you are not eating a lot of plant roughage then you need to take it in supplement form. I think Dr Atkins recommended psyllium husk. But that would be another BLOG post…

This was originally a multi-part series from Aug 2016 where I explored the possibility of drinking beer and doing Low Carb.

Remember the food metabolism curve (Only Three Things in What We Eat)? That graph is only missing one thing. Alcohol.

The conventional wisdom (which seems to be repeated from Atkins) I have heard but now question is whether or not the body only burns alcohol if there are choices between alcohol and other things in the body. Alcohol is the best choice of all for the body in terms of ease of access so I wrongly concluded that the body puts off dealing with proteins, carbs and fats until the alcohol is metabolized.

The Atkins site (Q: Can I drink alcohol now following Atkins 40??) puts it this way:

The body burns alcohol for fuel when alcohol is available. So when it is burning alcohol, your body will not burn fat. This does not stop weight loss; it simply postpones it. Since the alcohol does not get stored as glycogen, you immediately get back into fat burning after the alcohol is used up.

Take careful note. They say that the body won’t burn fat but they don’t mention carbs or protein.

The truth is that the body burns all of the sources as best it can in some blended way. Some are more easily accessed than others and burn more quickly. Some are burned slower but all burn at the same time. Alcohol has it’s own curve for blood concentration (implicitly related to metabolism):

Also, Atkins can’t be right with the word “immediately” since this is such a long and smooth drop. What does make sense is that there are overlapping times when the alcohol level has reached a low enough point that the body has to start drawing energy from the stored energy sources. This isn’t a like a flipped switch at all.

Here’s some information on the interaction of Alcohol and other foods (Science here).

The concomitant ingestion of various foods with alcohol resulted in a decreased area under the blood alcohol concentration curve, a lower peak concentration and an increased time to reach peak. Michaelis-Menten kinetics indicated a decreased alcohol metabolism rate after the ingestion of carbohydrates or fats.

I think everyone who drinks realizes this (at least about carbs). If you eat food you get less drunk for both slower and longer. If you drink on an empty stomach you will get drunk faster but sober up more quickly. (PSA: Use those facts to whatever advantage you personally choose as long as you don’t drive. Find another way to stumble home than your car.)

However, that study does implicitly contradict the claim by Atkins. The study demonstrates that alcohol metabolism is reduced after the ingestion of fats. That implies to me that the body processes both at the same time. At least the dietary portion of the fat is still being burned. It’s not like the body puts the fat off into some corner and says that it won’t burn it until the alcohol is done. It does both at the same time. The alcohol acts slower but so do the other sources (Carbs, proteins and fats) just like they would in any other blended situation.

It is true that the body isn’t burning stored fat during that time, but that’s true of anything that a person eats. The body isn’t burning stored fat if it is getting enough energy from what you are digesting.

In fact the real story may be quite different. Take a look at the pathology of Alcoholic Ketoacidosis – a pretty serious condition (What Is Alcoholic Ketoacidosis?).

Cells need glucose (sugar) and insulin to function properly. Glucose comes from the food you eat, and the pancreas produces insulin. When you drink alcohol, your pancreas may stop producing insulin for a short time. Without insulin, your cells will not be able to use the glucose you consume for energy. To get the energy you need, your body will start to burn fat.

This is directly opposite of what Atkins says. At least for the alcoholic he has reached the point where his body is eating itself up by burning its own fat. That’s the exact goal of Atkins – to burn the body’s fat. The downside is that the blood glucose increases during that time. Note that this seems to take a lot of alcohol over an extended period of time but it does suggest that the alcohol itself does not prevent the body from burning fat.

## Craft Beer

My drink of choice is craft beers. I am particularly fond of the higher octane varieties like Southern Tier’s 2X IPA. The nutritional data for that beer is:

Note that the summary below doesn’t get it right since it doesn’t include the alcohol as part of the calorie count.

This can be shown from the math:

Calories from carbs are 4 cal per gm.
Calories from protein are 4 cal per gm.
Calories from far are 9 cal per gm.
Calories from alcohol are 7 cal per gm.

So 12 ozs * .082 (percent alcohol) * 7 (cals per gram) * 28 (grams per oz) = 165 cals from alcohol. Calories from carbs are 21.4 * 4 = 85.6 cals. Cals from Protein are 2 * 3 = 8. This is 250.6, a bit more than the earlier table but close enough.

## How Can I Keep Drinking?

So what’s the best strategy for drinking and losing weight/lowering insulin levels? The best approach is the “cut it out approach” but let’s look at the other choices.

First. seems like it would depend upon the type of alcohol. Craft beers, like the 2X IPA, have a pretty good carb count to begin with. That’s partly why they last longer in the body than say Jack Daniel’s Whiskey. Add to that the sheer volume of downing a 12 oz beer vs a 1.5 oz shot. Eating carbs lowers the metabolism of the alcohol and craft beers would have a slower effect than liquor.

Can it be explained by alcohol amounts? A 12 0z craft beer like the 2X IPA at 8.2% alcohol and 12 ozs has about one oz of alcohol in it. Except a person drinks it over an hour instead of 5 seconds it take to down shot.

If the goal is getting drunk then a few shots are a more effective way to get there. If the goal is to enjoy a few drinks over an evening than craft beer is a good choice.

I am convinced that there’s a dual effect of drinking carbolicious drinks like Craft beer with a meal. The carbs in the beer are one effect and the carbs in the food are another and they do add together. The LC treatment says both of these are bad and just cut them out.

If the goal is decreasing Insulin Resistance then it is believed to be helpful to drop the carb consumption. Carbs increase blood glucose levels requiring a quicker insulin response from the body than other sources of food (protein and fats).

The next question is then is it better to drink Craft Beer with dinner or wait a couple of hours and then drink. Certainly delaying alcohol gives the likelihood of drinking less which means less total carbs. Drinking a craft beer every hour or so from 5-11 would mean 5-6 beers which in this case would be 21 grams of carbs per beer. Basically a pretty decent carb load over an evening.

Delaying drinking until a couple of hours then has the effect of less drinking and less carbs combined with the advantage of letting the meal start to digest. If there are carbs in the meal they are then spread out and less bunched together.

So that is what I tried yesterday with success. I started dinner at 5 and ate for a short time. I then waited till 7 and drank beer at 7, 8, and 9 PM. I went to bed at 10 AM and work up at 5 AM to a fantastic blood sugar number of 111.

One thing I have noticed is that Rye Pale Ales do not blow up my Blood Sugar levels like other IPAs (wheat based Ales) do. Not quite sure why.

The carb levels look comparable. Hard to find anything out there on the difference and I’ve never met a diabetic to share the information with. I do remember that My grandfather had a wheat allergy of some sort and could only eat Rye bread due to some unknown digestion problems.

Is there an analogy to bread? The key may lie in the glycemic index/load. According to (The Glycemic Index of Rye Bread):

One slice of rye bread has a glycemic index of 41 and a glycemic load of 5, according to the Linus Pauling Institute at Oregon State University. In contrast, one slice of white bread, made from refined grains, has a GI of 73 and a GL of 10. A high glycemic index is considered 70 or more, and low is 54 or less; a high glycemic load is 20 or more, and low is 10 or less.

So if beer is really just liquid bread and the carb/alcohol numbers are the same, then it makes sense that Rye beer has a lower glycemic index and load over other Pale Ales of similar alcohol and carb counts.

I did a completely unscientific study and measured my BG at 111 and then drank a Rye Pale Ale beer. I then waited an hour and measured my BG and got 114. When I drank the beer I did not take a bolus like I normally would have in the past. I did the same thing a beer without a bolus and an hour later measured my BG at 112. The taste in my mouth tells me that I am out of ketosis. An hour and a half later my BG was 116 and I was solidly in ketosis.

This has been a disappointing year to find Rye Pale Ale. I bought one or two 12 packs and have not seen them at all over the year. Last year I could find Rye of the Tiger and other brands in the local beer distributors but not this year.

Beer can be healthy in moderation.

## Status from Aug 11 2016

Great start today

My weight was down 3 lbs from yesterday.

Set a New Basal Rate of .25 units per hour less.

Woke up at 5 AM to a Blood Glucose of 111. Did the bolus to get me from 111 down to 105 (just a few tenths of a unit). Took my number two hours later and it had jumped to 143. Rather than doing a 3 unit bolus I decided to do 2 unit bolus. Will be interesting to see the results I get. Wonder what would have happened if I had not done the few tenths of a unit bolus.

Yesterday’s Meal

I did a (rare for me) calorie count of my dinner last night. At 1661 calories. Did the percent of calories from various sources and got:

Carbs – 16.9%
Protein 11.31%
Fat 36.6%
Alcohol 35.2%

That’s a day of counting calories and taking into account the types of calories.

## Intermittent Fasting (IF) (Reposted from Aug 2016)

How does the Intermittent Fast work? Here’s another video by Dr. Jason Fung on Intermittent Fasting.

Dr Fung ties together some related points.

1. The Biggest Loser TV program. Contestants have been admitting it didn’t work for most people. Eat less, move more diets. Problem with this approach is that it lowers your metabolism and you need less calories after the diet. Calories in excess of that lowered amount get added to the person as weight. They can’t also keep up with the 5 hours of exercise a day.
2. Comparison group is people who have stomach stapling surgery. This procedure has dramatic cure rates for T2D. Difference is that it doesn’t reduce the metabolism like the Biggest Loser program. Metabolic slowdown has been well known for 100 years.
3. Calorie model treats us as one storage location but we aren’t like that. Incorrect model.
4. Two storage locations model (analogy: refrigerator vs freezer in the basement).
Short term storage – Eat food > Increase Insulin > Store sugar in liver/produce fat in liver. Limited capacity.
Deep storage – No food (Fasting) > Decrease Insulin > Burn sugar/fat in liver
5. Fasting is the only way to access the deep storage (analogy: the freezer). Insulin is what stops the movement out of the cell.
6. Insulin resistance locks away the deep storage in the cells.
7. Reduced calorie “Women’s Study” showed the calories in/calories out model doesn’t work. It ignores the role of insulin.
8. Fasting doesn’t burn muscle. It burns fat stores. It is against the way we were designed. Repeated fast/famine cycles in our history would have produced all fat people rather than thin people.
9. Low Carb and fasting as the intervention which empties out the fridge which allows access to the fat in the cells.
10. We were built to live through famines. We get energy from the fat stores in our bodies to go solve our famine issue.
11. Fasting does not put you into starvation mode. Reducing calories does that, not fasting. Over four days of fasting metabolism increases.

## Part 2

1. You will lose weight when you fast. Even for intermittent fasts.
2. Fasting is simple. Rather than doing something (buy special food, etc) you do nothing.
3. Fasting is free. It’s what you are not spending money on.
4. Fasting is simplicity. No efforts (shopping, cooking, cleaning).
5. Fasting is flexible.
6. Fasting can be added to any other diet. Low Carb and fast go along well.
7. Should have the proper medical supervision (good luck with finding that). Dr Fung’s practice has a 9 month waiting list.
8. Fasting has been done for 5000 years that we know about.
9. All major religions practice fasting.

Dr Fung’s message really hits home for me. I’ve been looking around for evidence to the contrary. Dr Fung reached his conclusions after years of treating kidney patients the old fashioned way and watching them get sicker.

His key insight is that high levels of Insulin is the problem not the solution to T2D. His second insight is that Intermittent fasting is an effective treatment for T2D.

Case Studies

Dr Fung has videos of patients who have gone from 100 units of Insulin a day down to zero units. Other doctors have case studies as well but there’s something particularly appealing about Dr Fung’s patients. They are older and in declining health due to T2D. They are on 100 units a day or so. Not the easy cases other examples contain.

## Mayo Advice #5 – Don’t Stop the Insulin (Repost from Aug 2016)

Here’s where they are totally right and totally wrong at the same time. From the Mayo Clinic site (Avoid weight gain while taking insulin).

Take your insulin only as directed. Don’t skip or reduce your insulin dosages to ward off weight gain. Although you might shed pounds if you take less insulin than prescribed, the risks are serious. Without enough insulin, your blood sugar level will rise — and so will your risk of diabetes complications.

I get what they are saying. If you need insulin to regulate your blood sugar and you go off it then you’ve got serious problems up to death. The thing a diabetic should be watching isn’t the amount you were prescribed. It should be the amount needed to regulate your blood sugar. No more.

My doctor started me out by telling me that I needed to take 40 units of long-lasting insulin. When that led to a high HbA1C number he said that I needed to add meal-time insulin. I wish they would not call it that. So many false things there. He told me to use the 2nd Insulin and use 8 units before every meal. The diabetic nurse told me that was wrong and she had him fix the prescription.

They got me nutritional training and told me to count carbs. Not count as in limit, but to bolus for the amount of grams of carbs in what I was eating. Good advice for high carb meals. Not great when you consider gluconeogenesis. That all got me to a decent point of glucose control but was about 60 units a day (40 of basal and 20 of “meal-time” (fast acting) Insulin. In the last 5 years I have progressed to around 100 units a day (varies by my carb intake). It’s only now that I am getting lower than when I was diagnosed.

I am using less by doing LCHF (really mostly LC) and Intermittent Fasting (IF). Yesterday I used a total of 47 units of Insulin. I will lower my basal (constant) Insulin rate tomorrow to drive my Insulin levels even lower.