Why low-carb is harder the second time around, part II

Despite the title of this post, it isn’t really about why low-carb is harder the second time around per se. It’s more about attitude toward dieting and why diets in general are difficult, sometimes even the first time.  What with it being a new year and all, I figured I would go ahead and get things stirred up early with my thoughts on the psychology of dieting.

I can’t begin to count the number of people whom I have seen in my office who have fallen off the wagon and who told me that they just couldn’t stick with their low-carb diet for any number of reasons.

A typical conversations goes something like this:

MRE: (In this drama, MRE is yours truly, the long suffering physician) So, Mrs. X, I see that you gained a little weight this week.  What happened?  Is there a problem we need to go over?

Mrs. X: Oh, no, not really.  I had to put my mother in the hospital this week, and I just couldn’t diet with all that going on.

Other answers could be: My kids all came home from summer camp, and I just couldn’t stick to it with all that going on.  Or my husband lost his job, and I couldn’t low-carb with that going on. Or I’m going through a divorce.  Or …  You get the picture.

These excuses bring to mind an absolutely wonderful book that I highly recommend, The Happiness Hypothesis.  It was written by Jonathon Haidt, an associate professor of psychology at the University of Virginia and is filled with interesting perspectives on happiness, what it takes to be happy and even the scientific basis of happiness.  The cover of the book has a sort of blurred photo taken from underwater of what appears to be an elephant with a rider on its back, which is central to Dr. Haidt’s thesis.

Dr. Haidt describes our minds and bodies (and by bodies he means not just our corporeal bodies but the working mechanisms of our bodies) as being akin to a rider on the back of an elephant.  Our conscious, thinking minds he casts in the role of the rider, and the rest of us as the elephant.  The rider can control the elephant as long as the elephant wants to be controlled.  And if the elephant is okay with being steered and directed, then to all appearances, the rider is in control.  But, if the elephant has other ideas, the rider basically just goes along for the ride.

Every time I think of this image, I’m taken back to our youngest kid’s dorm room in college where he played a bit of video he had taped from one of those Fox (I think it was Fox) shows from years ago called When Good Pets Go Bad.  It was a video of a woman who, along with her three young children,  went for a ride on the back of an elephant.  The elephant was a part of some sort of performance and had been placidly giving rides to all comers.  Once this particular family got aboard, the elephant decided it had put up with enough nonsense and went rogue.  It stormed out raising hell and tearing up everything in site with the poor mother and her kids hanging on for their lives. The family ended up unharmed after the rampage, but the elephant had to be destroyed.  Our kid loved the video showing all the people running in horror from this irate elephant and would play it in frame by frame mode so that he could see the looks of terror on all the faces of all those trying to flee.  MD and I, being the attentive parents that we are, must have watched this video a dozen times as he pointed out all the nuances that he loved so much, so it is firmly etched in my mind.

This rogue elephant scenario is what Dr. Haidt thinks happens to us from time to time.  Our rider (the conscious part of us) wants us to do something, but the elephant part of us doesn’t want to, and so the rider just hangs on for the ride while the elephant goes wherever it wants to go.  We can put this in dieting terms.  Our rider decides that the elephant needs to go on a diet.  As long as the elephant is up for it, the diet hums along.  But if the elephant has other ideas, the rider becomes an ornament.  If things are going well, the rider has the appearance of control; if things aren’t going well, i.e., we had to put Mom in the hospital, then the elephant takes over.  And the rider accepts it.  He says, hey, I couldn’t control this beast because we had to put Mom in the hospital, and you know how he gets when we have to put Mom in the hospital.  He wants to eat, and I, the rider, have to go along with him.

Yale psychologist Paul Bloom presents another way of looking at this situation in an enlightening article in the November 2008 issue of The Atlantic.  He puts forward the idea that we all have multiple selves that we’re constantly dealing with, arguing with and trying to fool.

Let’s say that we’ve dined large late at night and are headed for bed.  As we crawl into the sack with belly distended from a carb overindulgence and lie flat, we start getting the ol’ acid reflux feeling.  We sit up, burp, drink some water, rub our chest and grab for the Tums.  The self that is suffering says, ‘That’s it, I’m dieting tomorrow.  I can’t stand feeling like this, not for one more night.’  The next morning the self that wakes up is a different person who isn’t experiencing reflux, doesn’t have a distended belly and is hungry.  And, by God, hungry for some waffles, at that.  The feel-good morning self may not abide by the rules laid down by the refluxing self the night before.

Bloom relates a story told by the Nobel laureate economist Thomas Schelling about his own multiple selves:

As a boy I saw a movie about Admiral Byrd’s Antarctic expedition and was impressed that as a boy he had gone outdoors in shirtsleeves to toughen himself against the cold. I resolved to go to bed at night with one blanket too few. That decision to go to bed minus one blanket was made by a warm boy; another boy awoke cold in the night, too cold to retrieve the blanket … and resolving to restore it tomorrow. The next bedtime it was the warm boy again, dreaming of Antarctica, who got to make the decision, and he always did it again.

Then Dr. Bloom goes on to tell his story of his own dual selves:

Late at night, when deciding not to bother setting up the coffee machine for the next morning, I sometimes think of the man who will wake up as a different person, and wonder, What did he ever do for me? When I get up and there’s no coffee ready, I curse the lazy bastard who shirked his duties the night before.

We are all like this.  One of our selves makes a promise that another has to keep, or, more likely, try to weasel out of.  One of ourselves gets us in a fix that one of our other selves has to get us out of. ‘What on earth was I thinking? How did that happen?’ our responsible self says when our fun-loving self does something incredibly stupid.

My responsible self says ‘No golf unless you get this project finished first.’  As the day wears on and my golf-addict self realizes that there is still enough light to get in at least 9, and it says ‘Hey, I’m almost finished, I’ll do it when I get home.’  When I get home, my tired self who wants to grab a glass of Jameson and kick back says, “Geez, why didn’t I just finish this job instead of playing golf?  I’m a member of a golf club, for God’s sake; I can play any time, so why today when I had all this hanging over my head?’

And that’s the problem with all these selves.  At least all my selves, and, I suspect, most people’s selves.  These selves can outwit one another, and if the selves aren’t careful or if there isn’t a father-figure, responsible self towering above the others, not much gets done.

These two authors astutely identify the ways we as humans tend to deal with life.  And since the part of life were talking about in this post is diet, these observations apply.

Our rider says diet, our elephant, in the throes of hunger, says screw that, I’m out of here.  And the rider goes along for the ride.

Or our one comfortably-fed self gets us into a diet that our other hungry or our stressed-out self  wants no part of and so bolts.

If you believe these two psychologists, we are pretty much doomed to stay overweight, insulin resistant, diabetic, etc. because when it comes right down to it, we don’t really have any control.  What can we do as the rider of a runaway elephant?  What can we do if our good self makes the deal but the other self won’t keep it?

If you think these ways of looking at dieting are outlandish, just tell me how many times you’ve heard (or even said) these words about a specific food (high in carbs, usually):  I just couldn’t help it.  I couldn’t resist.  I gave in to the cravings. I couldn’t control myself.

Go back through the comments of the last couple of posts and read how many people wrote how they couldn’t deal with carb cravings.  Probably the most common excuse I heard for dietary indiscretion from my patients was that they just couldn’t control their diet when under some stressful situation.  The cravings got the better of them.

It sounds reasonable.  Psychologists write about elephants and riders and multiple selves fighting with one another because that’s how most people tend to react.  But it doesn’t have to be that way.  We are not that helpless.

Back in the early 1980s a psychiatrist, William Glasser, M.D., wrote a book titled Take Effective Control of Your Life that I read at the time and thought to be one of the more insightful books I had ever read.  The paperback version of that same book appeared a couple of years later under the title Control Theory.  Both editions are now out of print but pre-owned copies can be had for pennies from Amazon.  This is a book well worth reading.  And not just for dietary help.

Dr. Glasser has gone on to bigger and better things and has become famous for an an entire school of psychiatric therapy.  I’ve read most of his books, and profited from them all, but the one mentioned above is a true gem.  I don’t understand why it still isn’t in print.

The insight that Dr. Glasser had and that I recognized in myself and in my patients as soon as I read his book was that people spend all their time worrying and stressing about things they can’t control and end up ceding control over the things that they can control completely.

Going back to our example at the start of this post, my patient who put her mother in the hospital didn’t have any real control over any part of what was happening.  She couldn’t control her mother’s disease, she couldn’t really control much of anything that went on in the hospital.  But she worried constantly about these things she couldn’t control and abandoned her diet, over which she had total, 100 percent control.

People do this all the time.  One of the very few things we have complete control over is what we put in our mouths.  Unless someone hogs us down, pries open our jaws and force feeds us, we have total and complete control of our eating.  Yet how many times have we heard people say (or have said ourselves), I just couldn’t do the diet with all this going on.  I lost all control.

Dr. Glasser understands about the rider and the elephant and the multiple warring selves, although he doesn’t call them such.  And he has a game plan for dealing with them, which puts the control squarely in our hands.

He explains that all behavior has four components.  He doesn’t explain these in dietary terms, but I will.

1. the physiological component
2. the feeling component
3. the thinking component
4. the doing component

We don’t have any control over the first two and only partial control over the third.  But we have total control over the fourth, the doing component.  Let’s look at how this all works with food.

Imagine you’re sitting in your office minding your own business when a co-worker comes in with a box of fresh, hot donuts, sticks the box in your face and says, ‘Have one.’  What happens?

First, your physiology kicks in.  Your pancreas says, uh oh, here comes some sugar.  Better get a little insulin cranked out to get ready for it.  You get a spurt of insulin and your blood sugar starts to fall.

Then, as your blood sugar falls, you start to feel hungry.  And your stomach starts to churn as it gets ready.  This is the feeling component.  And you have no control over this.  It all happens and it is totally beyond your control.

Then you think about how good a donut would taste.  And you imagine it.  And you say to yourself, hey, it’s only one. What could it hurt?  This is the thinking component, and you do have some control over it.  But with the physiology and feeling components hard at work, it’s difficult not to think about the donuts.  Difficult, but not impossible.

And all the above happens in just a few seconds.

Then you grab a donut and eat it.  The doing component.  You have complete control over this component.  You choose to eat the donut.  All the other components are ragging on you and you cave.  And you say you had no control, but you really did.  If someone had told you they were going to shoot you if you ate one of the donuts, you wouldn’t have eaten it.  All the other three components (at least the first two) would have been acting the same, but you wouldn’t touch the donuts.  You can control the doing component if you want to.  Problem is the other three components gang up on you, trying to disable your will.

But, this can all the dealt with.

Dr. Glasser realized that the physiology to feeling to thinking to doing progression could be reversed.  Since you have complete control over only the doing component, you’ve got to do something.  And once you do, you can foil the progression. Because if you take different action, you can drive the progression the other way.

If you get up from your desk and say, No thanks, then leave your office and go involve yourself with something else all the components start to fall in line.  Once you start doing something different, you start thinking about it, then your feelings of hunger go away and soon even your physiology falls into line.  Your liver produces glucose to make up for that the little spurt of insulin knocked down, and soon you’re back to normal.  And it doesn’t take all that long.

So, basically, we can be driven by a progression over which we have no control to abdicate the one thing we do have control over, our actual active doing.  Or we can use our ability to do something to reverse control all the components that we don’t have direct control over.

Realizing that I had this ability to control the seemingly uncontrollable made a huge difference in my life years ago and continues to do so today.  Knowing that I can control virtually any behavior, but especially my dietary behavior, by simply focusing my attention and effort onto a task or other activity has kept me on the straight and narrow multiple times when strong temptation fell in my path.

If the high-carb demon is goading you to go face down, telling you that you have uncontrollable cravings, just force yourself to go do something else.  Soon the cravings will be gone.  It takes a little practice, but it helps to repeat the mantra: I have 100 percent control over what goes in my mouth.

Take the advice of Dr. Glasser.  Start worrying less over those things you can’t control and accept that you have no control over them.  And take back control of the things you can.  If you do so, you will be a much happier person.  And a much thinner person.

Please note: I reserve the right to delete comments that are offensive or off-topic.

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84 thoughts on “Why low-carb is harder the second time around, part II

  1. Hello Dr. Eades,

    Thank you for all of your posts on this topic.

    I had a sorta related question that ties back to a study/passage in GCBC.

    In it, Gary refers to a doctor who had patients on a 360 calorie diet that was VLC or no carb (can’t remember, my dad has my copy of the book). I believe he said that it was interesting that on this type of diet that hunger was minimal to non existant and that people dropped a lot of bodyfat.

    I was curious as to your thoughts of this kind of plan for a short term (wedding prep) fat loss. I am usually am on a low carb diet (<20 grams per day) and I have lost but tend to not lose as much because of screw ups (I am one of those people who need the post you just wrote). I was thinking about something more along the lines of 800 calories of just meat and fat for a few weeks and see how I do to get to the next level and punch below 180 lbs for the first time since college

    thank you again for everything

    Assuming everything else is okay, I don’t see a problem with a low-calorie, all-meat diet. Most people following such a diet lose pretty quickly.

  2. I’d like to hear you address a different component of diet failure: a sense of betrayal. This is also a very big part of giving up. When you have done absolutely everything according to plan–not so much as a single potato chip, pinch of bread, ounce of alcohol for weeks at a time–and the scale goes up and the waistband gets tighter. This is a very real experience for many of us. Weeks and weeks of carb counting, calorie counting, supplement swallowing, weight lifting, for naught. The doubt begins–have I invested in the wrong diet? Are the books I am reading wrong? Am I and my elephant charging in the wrong direction, getting more and more hopelessly lost?

  3. Very good post Dr Eades.

    I liked the 4 dimensions of behavior… I suspect that a major reason successful long time low carbers like yourself and myself are able to do it primarily because of the 1st and the 3rd. I’m not so sure the 4th is active, it seems more passive. What else motivates behavior if not body, thoughts, or feelings? Action cannot come from nothing, unless we believe in possession by spirits or if one is suffering a sleep attack or epileptic fit of some kind haha. Feelings probably work by indirect means, by influencing body and thoughts.

    I think we must pay more attention to the neurotransmitter/mood modulating effects of food. There is a reason so many people cannot seem to maintain a hunter-gatherer way of eating when glucose is freely available, but ONLY during emotionally challenging times. I have mood disorders, but I am fortunate that my mood disorders respond to food restriction and low glucose. I do know what it feels like to have dysfunctional feelings, and it is intolerable and you would do anything to fix it. It is a pain and dyscomfort that easily rivals or exceeds physical pain like hunger.

    In this sense, expecting someone to low carb with a carb dependency is sort of like expecting someone to follow a traditional low fat diet. You are asking them to starve for dopamine, endorphin, serotonin… this is not reasonable when someone is under duress of stress. It is unreasonable to expect a reactive hypoglycemic to stick with a low calorie low fat diet, and it is unreasonable to expect a person with a carb-responsive mood disorder to low carb consistently.

    I think the reason I am able to low carb consistently is only because my mood disorder is made radically worse by carbs. My head fills with chaos, I become barely functional. I only ever feel normal, calm, motivated, happy, when I am on the threshold of ketosis. I am not a carb addict at all, I am the opposite. I receive no reward from eating bad food because the way I feel after eating it is so immediate and so horrible that I literally fear carbs … I have a conditioned fear response of rice and pasta and large portions of donuts, the way any normal person has of putting your hands on a hot stove. My brain just says “NO NO NO IT WILL FEEL SO BAD”. It begins with a mild feeling of sadness and lack of motivation and hopelessness and it just gets worse and worse and worse the longer I stay out of that cusp of ketosis. Protein makes it even worse. The only hope of normal mood is feeding my brain fat and this is only possible when I remove the glucose from my blood like an exorcism.

    I suspect some type of antabuse like drug will be part of the cure for many overweight people. If everyone had a brain melt down when they ate garbage, the way I do, everyone would effortlessly low carb. Antabuse helps alcoholics by making them immediately sick if they consume alcohol. If fat people immediately felt worse after eating carbs, they would stop eating them. The problem is most fat people, like alcoholics, feel better in the short term and only feel worse in the long term. They need to invent a carb-dependent form of antabuse.

    With proper nutrition and abstinence of carbs I suspect that mood problems will normalize after a few weeks. Food will stop seeming necessary to feel good when the receptors in the brain normalize.

    It seems like the dopamine system is particularly mutilated by overfeeding. Obese humans, like rats, have an inability to respond to dopamine normally but experience an exaggerated dopamine response to eating. Food restriction corrects this imbalance (lean rats and restricted overweight rats are both dopamine sensitive).
    Thing is, it requires a detox period, and it lasts a lot longer than the “induction flu”. It would be a good point to stress in diet books that dieting gets easier with time, primarily because ability to feel happy and good without food is restored after long term abstinence .

  4. Jerry Seinfeld has a funny stand up bit about our multiple selves:

    I never get enough sleep. I stay up late at night, cause I’m Night Guy. Night Guy wants to stay up late. ‘What about getting up after five hours sleep?’, oh that’s Morning Guy’s problem. That’s not my problem, I’m Night Guy. I stay up as late as I want. So you get up in the morning, you’re ….. (?), you’re exhausted, groggy, oooh I hate that Night Guy! See, Night Guy always screws Morning Guy. There’s nothing Morning Guy can do. The only Morning Guy can do is try and oversleep often enough so that Day Guy looses his job and Night Guy has no money to go out anymore.

  5. “ScienceDaily: Your source for the latest research news and science breakthroughs — updated daily

    Women Cannot Control Their Hunger As Well As Men, Study Shows

    ScienceDaily (Jan. 22, 2009) — A ground-breaking brain-imaging study at the U.S. Department of Energy’s Brookhaven National Laboratory shows that men, but not women, are able to control their brain’s response to their own favorite foods. The study, which will be published online by the Proceedings of the National Academy of Sciences the week of January 19, 2009, may help explain why rates of obesity and eating disorders are higher among women than men, and why women typically have more difficulty losing weight.” (more at link: http://www.sciencedaily.com/releases/2009/01/090121211340.htm)

    Sometimes the elephant really exists.

    Or at least we think it does.

  6. I’m not a low carb eater per se right now (I just can’t sprint as hard as I need to in ice hockey without a moderate carb intake and I’m playing 4-5 times/week right now. It’s kind of a pain because low carb is more convenient in a lot of ways), but I do avoid wheat still because of my allergy. There are some trouble spots (e.g. it’s tempting to just go ahead and use the damn soy sauce if I’m out), but on the whole it’s pretty easy to keep myself on track because the consequences are unpleasant and fairly immediate. For an ordinary dieter the only real consequence is not losing weight, which is I think a little too abstract to really be completely motivating.

  7. Ah, now you’ve roused the moral philosopher in me:

    The description in terms of multiple selves sounds like a person living out Hume’s bundle theory of the self. Undoubtedly, that’s how some people live — as streams of here-and-now thoughts and desires. Such people are easily derailed from their seemingly well-laid plans by seemingly minor disruptions. They’re at war with themselves because they’ve not integrated their reason with their emotions. They have certain goals, but they’re too distant, too unclear, too vague. So their immediate desires, feelings, and pleasures can lure them to do things they know will frustrate and even harm them. They allow themselves to be pushed around by circumstances — and then they blame the circumstances, rather than themselves. That’s a recipe for failure — whether in healthy eating or any other serious endeavor.

    That kind of conflict between reason and desire is painful, degrading, and entirely unnecessary. A person can organize his life around rational, long-term goals. He can cultivate desires and emotions that support the achievement of those goals. That requires ruthless realism about oneself and the world — including distinguishing between what you do and do not control in life.

    Two philosophers are particularly noteworthy for their insistence that a proper human life is not a war between mind and body or between reason and emotion but an integrated sum, lead by reason: (1) Aristotle and (2) Ayn Rand. Aristotle can be tough reading, but his _Nicomachean Ethics_ is a gold mine of practical wisdom. Ayn Rand is more accessible: I recommend starting with her novels _The Fountainhead_ and _Atlas Shrugged_.

    Life can be so very good — if you’re not that person riding passively on the back of an elephant that might go berserk at any moment.

    Diana Hsieh (Ph.D Candidate, Philosophy, University of Colorado at Boulder)

  8. Wow, this is incredibly timely and much appreciate. Timely because I just started going to a therapist yesterday, some of which is at least on face value unrelated to also being diabetic, but some of which is, in particular my stated (to the therapist) desire to become rational about things which will kill me if I am irrational about them. Being, as I say, diabetic, this obviously includes, very prominently, how and what I eat. Being irrational about it can and will maim and kill me. I don’t know that I’m immediate danger of that, but I’m clearly not as rational about it as I know I need to be — much like the elephant rider. Oh, look, corn chips! Well, I had a bad morning, so just this once. Etc.

    So your suggestion (by way of Dr. Glasser, whose book I will pursue now) to, instead of just saying I Must Not Do That, instead to Do Something Else Instead — yes. Very timely and helpful, I think. Brainstorming ways to make use of that. Thanks again.

  9. Another way of looking at this issue is through what economists term time preference, or the ability to defer gratification. The famous Stanford marshmallow experiment, in which four-year-olds were placed in a room with a marshmallow, and told that they would be given another one if they could refrain from eating the first while the experimenter left the room, showed that a higher ability to defer gratification was highly correlated with success in life. This is a good example, too, because it dealt with food. I suspect that this is the reason that there is a socioeconomic stratification of obesity – i.e. those with higher income and greater intelligence are less likely to be overweight.

    • DennisM-

      I find your comment offensive. I would see it as people with higher income have an easier time making better food choices, because good food costs more than the processed, transfat-laden, inferior, and very cheap garbage disguised as “food”.

      Just because a person is poor doesn’t mean they are also stupid.

  10. Interesting low-carb tidbit…

    Today I was reading about a very poor Mexican family living in the 1940s. Even though they walked 4 hours (round-trip) to work in the fields all day, and even though they barely had enough food to eat, most of the adults were chubby. Perhaps the reason is that their diet consisted almost exclusively of corn tortillas, because they couldn’t afford luxuries such as meat – and I don’t think they had much oil available either.

    I agree. I am in Mexico at this very moment, and all day long I saw people who are struggling economically and use their feet as their mode of transportation, yet are fat. Carbs are cheap.

  11. Dear Dr. Eades,

    Just a quick note of appreciation from a newcomer for the generous time and attention you give to this blog. I discovered you thru Janet Ruhl’s excellent blog, Blood Sugar 101, read ‘Protein Power’, then resolved my pre-diabetes in days. To boot, my lipids are now embarrassingly good. To say I’m a satisfied customer doesn’t really state the case. (But why oh why do I wake up with a blood glucose in the high 90’s nearly every morning only to watch my levels fall to normal by noon and remain there until around 4:00am the next day. If this is the so-called ‘dawn effect’, buddy, it sure is a long one!)

    Per your present post: We all know how one’s larger emotional life can affect self- destructive behavior, even when it’s something as innoccuous as that one donut (a gateway ‘drug’ indeed.) Over-worked, under-appreciated people who have long standing emotional issues are at a particular disadvantage when it comes to compliance (over time) to any diet. Is it any wonder that teachers and nurses–college educated people, after all–are among the most overweight people of any demographic? It’s a sad but true fact that everyone will get his or her reward from SOMEWHERE and for many many people with only limited outlets (at least as perceived by themselves) carbohydrate treats often become the reward of choice. Not to say one can’t say no because I always do (that glucose meter is hugely re-inforcing by the way) and many many people also so ‘no’ day after day, of course, it’s just that it’s so much harder when you life lacks many of the fun, supporting things that you or I might take for granted. We, fortunately, anticipate our more healthful rewards all the time. As appalling as “The Biggest Loser” might be, those featured over-weight people are, for better or worse, being re-inforced mightily for good behavior, in a way they have never experienced in their lives and they are therefore put in a place to achieve what was once almost unthinkable to them. Maybe all I’m really saying is this: Those who fail repeatedly to achieve or maintain normal-like weight will almost certainly benefit from some quality psycho-therapeutic intervention. And of course that means reimagining your life in a way that begins to reflect the best of who and what you are. Often people need permission to change and by at least trying therapy (and I stress quality therapy) maybe they can start the real journey of their lives, a big part of which can be finally ariving and staying at their proper weight.

    Pardon the little six inch soapbox moment there. Didn’t see it coming myself.

    Again, thanks Dr. E. for the great blog. It does inspire.

    Peter Maxfield

    Thanks for the comment. I’m glad you’re enjoying the blog.

  12. Vis ratioanlizations/many selves ..ever see the Big Chill. J Goldblum as i recall, maybe wrongly, says ‘Rationalizations are more important than sex’ When one or more of his pals disagrees he quips ‘ever gone a week without a rationalization!’

  13. Excellent post! And rather cringe-inducing, too, as I recognize myself all to well in those examples. I’ve added those titles to my book requests at the library and look forward to reading them when they come in at my branch. Some of the best books that I’ve read in the past year were at your recomendation, including Malcolm Gladwell’s “Blink.” He’s got a new one out called Outliers which I highly recommend.

    I ran across this quotation today and thought how apt it is when applied to statin drugs. It’s almost as if Sinclair was talking about them:

    “Advertising is a valuable economic factor because it is the cheapest way of selling goods, particularly if the goods are worthless.” Sinclair Lewis

  14. Good analysis! I went to a high school built and based on Glasser’s ‘reality therapy’ with full open concept and he would come check up on us. They went back and built walls and doors in the school after we graduated! Pretty interesting education. Maybe it did sink in actually – I have been a low carber for 12 years and seldom go off. I always think it’s strange when I hear the excuses and ‘see’ the results of America eating what they crave all the time. I just don’t get it – and though it never occurred to me before, maybe I have Dr. Glasser to thank for that.

  15. Stellar, I *need* to buy that paperback (I’m cheap). This seems to have applications to much in life. Can this be used not just to counter bad behavior, but to encourage/promote good behavior. Thanks for the heads up!

    I had a dozen glazed donuts dropped off at work today by a well meaning business associate! Second time this week! I too often get beer, nachos, pizza, donuts and any manor of carb-infested junk dropped off at work by friends, well wishers, and biz associates. But it has been a long time since a junk carb has crossed my lips. This post will help in that resolve all the more. Can’t wait to read the book.

    Why doesn’t someone bring me hardboiled eggs, jerky, smoked fish, or a nice piece of cheese for a change?

  16. I really like your emphasis on choice. Often, I have clients ask if they “have” to eat the way I’m recommending. I always answer, “of course not.” But anyone not happy with their current physical condition has to ask themselves if their choices (there “have to’s”) are aligned with what they really want. A month from now, what do I really want – to have had a doughnut or to have lost 10 pounds? Put that way, the choice gets a bit easier (but certainly not easy).

    I also find that once you make a few of those tough choices, momentum starts to kick in. Most people will reach a point where they feel like they are on a role and don’t want to break it. That’s where the real magic transformations seem to happen.

    Thanks for the interesting post.

    Cheers,
    Adam

  17. That is a great analogy of the rider and the elephant. Thanks for sharing. It’s amazing how consciousness can arise out of a mass of trillions of tiny creatures, some of which happen to have human genes. The ideas on self-control sound good too. In looking back, I see that sugar was once very addicting for me. I often used to give in, even though I new it wasn’t good. But I found that by eliminating foods with added sugar for long enough, I broke my sugar addiction. I no longer crave sweets and can sit and watch my wife and daughter chow down on goodies without the slightest temptation. Sweets don’t even look like food any more. If someone offers me a doughnut or candy, I think “poison” :)

  18. That aptly explains how I finally got control over the carbs. Instead of letting thinking move me to doing by dwelling on my sacrifice (“wow that bread looks good, too bad I can’t have any… well maybe just a little treat”), I just shut the thinking down and immediately change focus (“not interested… next topic”). Once I realized I did not have to identify with my “loss”, things got much easier.

  19. I love the analogy between happiness and self control. I believe both to be self-fulfilling prophesies. Our tendency is to think we are victims of circumstance – happiness is not ours to choose, nor are our thoughts and feelings. But happiness can simply be a decision as is the ability to deny that donut. I have experienced that reversed progression you talk about – mustering up every bit of strength to resist a craving and it losing its power only to become weaker next time it strikes. It is very empowering when you realize it is just your perception that is a big as an elephant. I know all this to be true so when I do succumb I attribute it to the brat in me that just wants to get its way sometimes. :)

  20. PS to the above: a) I had no idea I had written anything of such length, probably because this little comment box tricks the brain into believing otherwise. And b) upon a re-reading I definitely winced at my saying I always say no to extra carbohydrates. This is not pride but rather because I am slightly neurotic about raised blood sugar levels as my mother has alzheimer’s (raised glucose levels are very hippocampus unfriendly.) And also, I suppose I am still in the honeymoon phase of the LC way of eating being just six months in. That said I am so happy to never feel that awful post-meal lethargy anymore that it is really going to take some kind of sinful carbs to knock me off this wagon. It’s just a much better way of life for me.

  21. Thanks for another wonderful blog. I would also add that Eckert Tolle’s books, The Power of Now and A New Earth, discuss that when we develop an awareness that we are thinking–instead of just unconsciously thinking–that awareness of the thought gives us control of the doing. When you become aware that there is the you who notices the you that is thinking, you suddenly wonder who the thinking you is– it is your ego that wants to control your actions. And it’s not often your friend–because its fighting for its existence in the physical world. The aware you is the spiritual component; the ego you, the physical. Once you can catch yourself being aware that you are thinking about eating the donut, then that split second gives you space to make a choice to not eat the donut. Does this make sense to you?

  22. WHOOOO! Heavy! Awesome Post Doc! I am glad you took the time to type it. Now I need to get to ‘doing’ something like getting to bed so I can get to the gym early!

    Whoo! Heavy!!

  23. Very interesting post. The multiple selves idea has a lot of resonance with me. Having recently had a period of excess over Christmas, I had briefly lost the ‘understanding’ I normally have between two of them. Over the years I have developed reminder mechanisms – so the hungry, tempted self who sees the bad food has been so bullied over the years by future, pissed-off self who deals with the aftermath that hungry, tempted self dares not eat it. He thinks “oh yeah, if I do that, my other self will not be happy.” But recently hungry, tempted self got the upper hand by rationalising everything in the context of Christmas and convincing future, pissed-off self it made sense to eat junk. It took a couple of weeks for future, pissed-off self to muscle back in and put hungry, tempted self back in his place, where he is now cowering contritely!

    Also interesting is the point about control. This is a big part of it for me. I find the control I can have over my diet particularly comforting when other things are out of control, and in this respect see parallels with the experiences of people with eating disorders.

  24. Thanks, Dr Mike. This post reminded me of that old commercial for aftershave – a brisk slap upside the head followed by the comment – Thanks. I needed that.

  25. Another thought, Dr. Mike – I think our success with anything is directly proportionate to the amount of priority we give it. We tend to get things done when we are really determined to. Most people have no realization of the magnitude of their power to do so. I don’t think there is anything truer than the old cliche ‘Reality is what you perceive it to be.’ Not sure if this comment is in sync with your message but as always thought this post was excellent and very inspiring.

  26. Dr. Eades, this doesn’t sound right. If self distraction and repeating a mantra were all it took, quitting cigarettes would be much easier than it is reported to be.

    I have only personal experience and no clinical experience. But personal experience suggests that there is an addictive component involved in carb consumption. It’s possible to overcome it with willpower, but in stressful situations, it’s hard to say no to the good feelings that many of us experience after eating carbs.

    Your thoughts?

  27. Sorry for the off-topic comment but it wouldn’t let me put it in the corresponding post. My credit card was billed for shipping on 12-27-08 but I have not yet received Protien Power. Any idea on when I can expect it? Anxiously awaiting…

    By the way, I’m getting even more than usual out of the topics and discussion this week. It’s like you’ve been inside my head. Scary.

    Sorry for the hassle. I’ll have Kristi check on it.

  28. Hi All–

    I am traveling in Mexico right now and have spotty internet service at best. Every time I’m able to get online, I try to deal with some comments. But when I do, it takes forever to go through the editing process. To keep them all from stacking up, I’m just going to approve them without commentary of my own. It’s much quicker this way since it is just one keystroke instead of the many required to go through the editing process. Especially since about half the time I lose my connection as I try to save and lose everything I’ve written.

    Best–

    MRE

  29. Hey Jerry Seinfeld has an episode about the two selves – late night Jerry would always screw over early morning Jerry. Who came up with this idea anyway?

  30. TO KATHY:

    YOU ARE NOT ALONE. Yes, as a menopausal woman, I know how hard it is to stick to a LC diet because of (serotonin?) crazies attack so often. And even when I do stick closely to PP, sometimes I lose very little weight. But I know it’s the best diet in the world, and I will never give up.

  31. Your prior articles hit the areas that are problems for me personally, nevertheless I really enjoyed this post. Our book group was discussing “Breaking Free” in Eckhart Tolle’s “A New Earth” this week. As a previous poster noted, it is really relevant to this topic.

    The opposite side of this is anorexia. Some people respond to lack of control over life by taking total control over food. So the goal as you say is to become conscious of the feelings that trigger the eating. It is deeper than just taking control. We have to see the elephant too.

  32. Really interesting! I definitely found this to jibe well with my own experience.

    I’d like to share a technique I use on the action-distraction front, which others might find helpful. I keep around, both at my office and my house, some foods which are rich in fat and which I find delicious and indulgent, but which are low in carbs — at my office it’s a jar of really good olives, and at home I usually have the olives and also various fancy cheese, and pork rinds because sometimes it’s the crunch that’s the appeal of the carbs. And if it’s really a bad day, and the carbs are callin’ my name at increasing decibels even after other distraction attempts, then I give myself permission to just totally go face down in one of these foods. And I might eat a whole jar of olives, or half a pound of cheese, or the whole darn bag of pork rinds (or maybe half WITH queso dip), at a sitting, until I darn near make myself sick with it. This totally wrecks the day in question for weight loss, of course, but what it DOESN’T do is wreck the next week also by setting up a blood-sugar roller coaster and an additional 3 or 4 binges, which is what would happen if I ate an equivalent caloric load of carbs (and that’s if I stopped there — satiety kicks in with the fats, but I can eat a whole lot more in carbs; dry cereal is one of my carb-binge foods and I’ve more than once eaten an entire large box of FrootLoops, which is about 1500 calories, compared to 800-ish in a half pound of cheese). And if a person is doing low-carb for reasons other than weight loss, then it doesn’t upset your plan at all.

    I am completely behind the idea that distracting yourself with a non-food activity is preferable, but sometimes it just doesn’t work, especially for those who tend to eat for emotional reasons, and not just because some carb-tempter trailed a box of donuts across our paths. This method won’t save us from the emotional consequences of self-medicating with food, but at least we won’t get in a physiological train-wreck at the same time.

  33. Yes, you’re quite correct. Rationalization is very easy to do and we all do it. There is a proverb, I think it’s Chinese, that goes something like: “Recognizing you’re a fool is the beginning of wisdom.” We have to admit to ourselves when we’re rationalizing. All the way down to saying, “I’m really NOT rationalizing!” – the granddaddy of ’em all. We simply HAVE to control what we put in our mouths.

    In this society though, I think there is at least some subliminal sabotage going on since we are ALL bombarded day and night with inducements to eat sugar, sugar, sugar (one sweet crunchy bowlful) and warnings about fat, saturated fat, red meat, etc. There’s no end to it.

    An interesting take on the multiple selves concept is the Star Trek episode where Kirk gets split into his aggressive, compulsive, out-of-control self and his introverted, indecisive, immobilised self. Separated, they are each a nightmare. But fused, each controls, balances and synergises the other perfectly (at least almost).

    Now, where did I leave my bearcat stew?

    Cheers, Jim

  34. Dr. Eades, you hit the nail on the head. I can’t tell you many times i’ve been that person in bed at nite feeling awful & resolving to NEVER eat certain foods again so as to spare myself such future misery. And then in the morning, well, it seems like a dream & my new “rules” seem a little extreme –(what was I thinking?) It’s like I’m 2 different people! Maddening! And your example about the woman whose mother was in the hospital was especially illuminating — every time I go to visit my ailing 80-year old father in the nursing home, my diet resolve vanishes & I find myself eating a carton of ice cream — as I make up a list of suggestions for the doctor! Wow. You’ve touched things on a very interesting (& potent) level & have given me much to think about.

    Thank you,
    Mary

  35. Here’s an example of a trick I use. Let’s say that I’m really craving a candy bar while I’m out somewhere. If I give in to the craving, but want to limit the damage, I will immediately break off half of the candy bar and throw it in a trash can, which is easy to do when you still have the other half to eat. If instead you say to yourself that you’ll just eat half and then throw the rest away, well, we all know how that ends.

    A similar trick is to immediately throw away the bread from a sandwich. If instead I leave the bread on my plate, I will invariably start picking at it when I’m done with the guts of the sandwich. And before you know it, it has all found its way down my pie-hole.

  36. Once again our “Miss Cheery, busybody” brought in cheese bread for the morning coffee meeting which she baked herself (selfless person that she is and with a spoken demand that everyone acknowledge that she is). The odor coming from it was making me sick, the same with the baked goods smells emanating from the cafeteria.

    It’s easy to keep the elephant tame when you actually smell the badness in foods with carbs in them. I’m so glad I have reached this point.

    Once again, Dr. M., you are a gem. Thanks for your excellent blog.

  37. i’m sure this strategy will be very helpful for many. However, as with hormonal balancing, I would like to see some exploration and support for brain chemical balancing as well. There is a big difference between lack of will power and true addiciton. Many people use carbs as subconscious self medication for very real brain chemical imbalances. I know as a long term alcoholic that when my brain shifts into a severe craving state, I become a different person. I am pretty much insane in those moments and I am not necessarily capable of making rational decisions or contemplating my actions. These mental/feeling states can be truly untenable to the point where it seems like a choice between caving in or dying/going crazy. For those who have never experienced a severe physiological addiction, I realize this might be hard to understand.

  38. I kinda like John Brunner’s desription of the brain as a man riding on a dog riding on a lizard.

    I also have experiences when the three things go off in different directions simultaneously.

    My cortex likes novelty. My midbrain likes routine. My brainstem likes donuts. Well it *did* actually prefer savoury carbs to sweet ones, but carbs nonetheless, I think the other two guys have beaten it into submission. For now. It’s learned to appreciate the lack of neuropathy among other symptoms, and not having to doze off from high BG or freak out from reactive lows. Nice lizard. There, there.

  39. Tim hiya i’ll arrogantly have stab at why folks bring high carb gifts;it’s cos of the complete understanding, manifestation not mechanism, of how they make us feel in the initial..the outpourinjg of dopamine.
    Fat and protein don’t do this…..deadly subtle and after a lifetime of bludgeoning subtle is the last thing we ‘feel’/see.

    You should see what all our residents…..chronic drug users….eat and crave…high starch high sugar.

  40. Both were very good posts, Dr Mike. In therapy (yep, tried that, too) my therapist talked about the “beach ball effect.” Trying to control certain emotions (like the ones associated with stress that can lead to cravings) is like trying to hold a beach ball under water. After a while you just can’t hold the ball under water, and it will literally explode out of the water…same thing with the emotion.

    This last attempt at LC, I held the beach ball under the water for almost 2 years, the last year-and-a-half of that being fighting and clawing and to try to force myself to stay on plan with the kind of sheer will you advocate–but mostly going back and forth between zero carb and face-down-in-it. It wore me out, and like every other time, I just said “screw it.”

    Interesting that the biggest and most popular LC books (yours and Atkins, at least for me) approach the diet as “just do it.” I think that if it were truly that simple, the success rate would be much, much higher, don’t you?

    You said in a comment once that you don’t crave food in times of stress, so how can you possibly know what it feels like for those of us that do? You can’t.

    I don’t crave food in times of stress because I have learned to distract myself. My wife has a post on the subject of cravings today that you might like to read.

  41. OK, I obsess over the damned # on my glucose monitor. My life since diabetes diagnosis last August is all about those numbers. I’m frustrated with feeling lousy ALL the time – I felt better when my BGs were in the mid 200s & I was blissfully ignorant and Metformin- & Januvia-free! I can’t control my liver’s pumping out sugar…1500 mg metformin ER or not, but I can control what I eat…between 0-15 gms carb (veggies & nuts only) at a feeding.

    In Dec, I got sick…bronchitis…turned into asthmatic bronchitis, hadda switch antibiotics, put on Prednisone (there went my BG averages of 130-133 slowly getting lower) & a rescue inhaler, Mucinex, Tussionex Rx in case my Splenda hot cocoa (gotta luv that unsweetened Ghirardelli cocoa) didn’t suppress coughing enough. 30 mgs Prednisone helped me feel better and shot my BG up into the 200s..yikes…on exercise bike at 2 am pedal slowly a few mins, stop to cough, pedal some more, stop to cough…did that for 20 mins…BG eventually dropped to 170 – this is horrible..no way am I gonna take 60 mgms the next day. I missed the holidays, got over the worst, and then caught a head cold. Feeling so durned bad I searched for patient reported Januvia side effects and I gotta ’em all it seems *sigh*…esp the depressed immune system (like I needed this), so I dropped it a wk ago Tuesday (so far my BGs seem to be up some, average is now 143 but I’m still sick). I’m finally back to riding my bike every morning: 10 mins minimum, 20 is max before I start coughing/wheezing. Inflammation: rescue inhaler (steroid) as seldom as possible, DHA, Coramega fish oils, fresh ginger, garlic, sm amts onion, curry, just switched to Ubiquinol, upped to 2K D3 (was very low, now barely into ‘normal’). Morning BGs been 140-150s, eat an oz of cheese/egg & 6 oz low sodium V8 & hot cocoa on drive to work, 2 hr PP is up 30 pts…bizarre…then I eat b’fast & 2h PP is down to morning BG — what is going on? Not enough protein? Why is my liver pumping out so much sugar? Too much illness? Too much wk stress? Too much obsessing over that number? Too much of just too much? I just had 5 ozs fish with ¼ c tomatoes, ½ c celery, 2 tbsp onion, 2 cups mixed lettuces, 1 tbsp carrots, 1 tbsp pine nuts, 1 cup SF cocoa (4 carbs): BG pre 147, 2 hrs PP 170…so discouraging (I keep telling myself I’m still sick…it doesn’t make me feel any better)

    I’m using my emWave for stress mgmt, I listen to soft jazz/new age at work, I try to talk to a friend 2-3 times a day, I talk to my 2 diabetic buddies for support (35 yrs diabetic, 30 of ’em on insulin, now on pump & on kidney transplant list, the other is legally-blind from retinopathy), I cook w coconut oil & unsalted butter, I try to read something educational/interesting on my bike and something for fun too, I play Zuma and spider solitaire regularly, tomorrow’s entertainment will be the HD broadcast of the Met Opera’s Orpheus & Euridyce, I experiment with low carb cooking & revising/converting recipes I love. I get 8 hrs sleep, usually refreshing. I scheduled an early appt with apnea specialist to evaluate my sleep apnea progress since diagnosis Aug07; chronic congestion & bleeding sinuses (thanks Januvia) are proving a real challenge for nCPAP.

    I’ve lost 45 #s, have more than that to go; my past HA1C was 6.9 down from 11. I can barely appreciate my progress ’cause I feel so lousy all the time *sigh*. But, intellectually, I know I’m getting better even though I seem to be in some sort of setback now. I have not lost hope that I can deal with this successfully; my determination is immense, including staying off insulin that will ONLY reduce sugar by driving it into fat cells. But, I keep coming back to why is my liver pumping out so much sugar? If I need only so much for daily maintenance/exercise, why is my body producing so much? Is some internal sensor out of wack? Is this fixable? Can I do anything to ameliorate this situation? My goal is 35-45 mins/day on exercise bike.

    Thanks for these:
    1. the physiological component — I can’t control my body’s processes
    2. the feeling component — I can’t control how I feel
    3. the thinking component — I can use my thoughts to stay positive, on target
    4. the doing component — YES! I can control what I do.

    Thanks for these blogs, doc, they help keep me going.

    I’m glad they help. You obviously have insulin resistance at the level of the liver cells. Insulin slows down the production of sugar by the liver, but only if the liver cells are sensitive to its actions. With continued work at weight loss via low-carb you should see your liver insulin resistance improve.

  42. More and more information is motivating.
    After I read Good Calories, Bad Calories, I realized low carb wasn’t just about weight loss, it was about my health, and, after that, I never looked back.
    I work in a nursing home with sick, older people, and I stare into the possible future every day.

  43. Gluten free low carb is good for me for all kinds of reasons, one of which is control of pain. So you would think I have all the motivation in the world to not eat things I should eat. But I find my best intentions are undone when I eat with other people – especially when other people cook. Sure, I should just not eat it. But I don’t like being one of those difficult people who can’t eat anything everyone else is eating and makes the person who made the meal feel bad about what they cooked. Some times I do better with this than at other times. It is relatively easy for me to eat right when I am alone, or when I cook for myself. Which I do most of the time. And of course it is hard to eat out. And it makes it especially hard when the meal I eat with others is a holiday meal. Then I feel like I’m being a real jerk for not taking part in eating. Those are just my own personal challenges. But I am the one who does the shopping, and I the eating, too. I get better all the time at choosing wisely. Maybe some day I will figure out a way to spare the feelings of the cooks and hosts and yet save my own food way.

  44. My first time with LC was during the last trimester of pregnancy with gestational diabetes, 11 years ago. That’s a powerful motivation to “get it right”, even though I had little recipe support because of the “Low Fat diet” influence, but I had excellent results with BG control and healthy weight gain and delivering a healthy mid-weight baby. And of course, it wasn’t “terminal”.

    My main gripe that time was the boring separate “piles” of food on my plate and the amount of time to weigh and calculate carbs before eating (I hadn’t yet discovered LC cookbooks with all that done calculating in advance). Unfortunately I was advised I could go back to my “normal” diet after the pregnancy and nothing other than fasting BG was monitored after that. So I did go back to my “carb queen” ways, though perhaps with a bit less enthusiasm than before.

    But even going back to carbs, my paradigm had already started to shift, with the realization that a) grains and starches aren’t *essential* for good health, b) I had to adopt LC for BG control at the point in the pregnancy when I had started to gain weight too rapidly, so LC prevented me from gaining too much weight (I gained 28 lbs) and the small excess I did need to lose (14 lbs post-natal) was quickly lost with 6 mos of breastfeeding), and c) that I needed more protein than I had been consuming, and that eating enough fat was essential for good glucose control, too. So if hadn’t been for this GDM diagnosis, I wouldn’t been *primed* for accepting LC as superior to the Low Fat advice from the “authorities”, nor would I have continued to investigate GDM and risk of later development of diabetes.

    However, five years, one new bread machine (that I loved to use), and a 20 pound post-weaning weight gain later with no weight loss from several months working at the gym, I accidentally started LC again after buying Dana Carpender’s 15 Minute LC cookbook (for the 15 minute aspect). So while that was my 2nd LC effort, it was the first time doing LC for weight loss. I ditched my high carb cookbooks and replaced them with LC cooks for meal inspiration. I read every LC advice book I could find and reviewed the biochemistry. I didn’t follow any plan, but after some time weighing and counting carbs, I could “eyeball” it and mostly just stuck to naturally low carb, real foods prepared at home (I kicked the heat & serve and take-out habits). The weight came off, my husband joined me in LC (at least at his meals at home) and I’ve never looked back from LC. Traveling can be a challenge, especially staying in someone’s high carb home (and breakfast in Italy!). But now that I know I have Impaired Glucose Tolerance (probably had it all along, even before pregnancy, missed by my docs except during pregnancy) with the meter I bought on my own, I know I can get diabetic BG readings with even fairly modest amounts of high carb foods. So knowing how far along I already am on the diabetes “spectrum”, I am quite motivated to stick to a LC path with relatively few high carb distractions. And I can see with my glucose meter that eating high carb food creates cravings when my BG is rolling up and down rapidly. I’ve got a kid to help grow up, I’m only 47, and I don’t want to succumb to diabetes and all its complications any sooner than I have to. LC is now just a way of life in our household, the default, even (for the most part) for our 10 yo son. He is my most powerful incentive, because I have to set a good example for him and help him learn now how to choose what to eat, for a long, healthy life.

    One thing I’ve only realized recently become aware of, however, is how wheat, even low carb wheat options, are a potential pitfall. Prior to the second round of LC (for weight loss, then maintenance), I was baking bread in a bread machine, and using added wheat gluten in the recipes. Then in the first two years of LC, I ate a fair amount of LC pita bread, which contains added wheat gluten and soy flour to boost protein and reduce starch (I dropped the LC pita because of the soy and a desire to get away from bread and packaged foods altogether). So for several years, no matter what the carb content, I was consuming a LOT of wheat gluten. I think the wheat gluten (& perhaps the soy, too) may have been what pushed me into hypothyroidism. The increased hypothyroid symptoms really interfered with life and eventually I figured that out and sought treatment.

    Now I know that both my son and I have gluten sensitivity (positive tests for IgA antibodies, anti-tissue transglutaminase IgA, and two copies each of genes that predispose to celiac and/or gluten sensitivity, and my son showed some mild fat malabsorption), which also means that my husband must have contributed the celiac-prone gene (there is overt celiac disease in the family of one of his cousins). So no matter what the carb count, we need to avoid wheat and gluten. LC readers who still indulge in LC baked wheat products and packaged foods (so many have added wheat gluten) might take note. Gluten-induced health issues include auto-immune conditions, GI symptoms and pathologies, nutrient absorption problems (especially fat soluble vitamins and minerals), and resulting dental problems, osteoporosis and bone deformities, CVD, cancer, & arthritis, stunted growth in kids, asthma, skin abnormalities, and more. It’s too easy to miss the gluten connection (& the tests are not sensitive enough in mild cases), though, and specialists are so focused, they often “miss the forest for the trees”.

    So wheat & anything with gluten, even LC wheat, is off the menu now at our house.

  45. What a wonderful post, Dr. Mike. You bring such a diversity of ideas and sources and compose them into well-organized, thoughtful, thought-provoking, and insightful posts. Thank you for that!

    I often describe those ‘caving in’ moments as under the influence of the Carb Monster who seems to completely take over my brain – like the elephant taking over the rider. But Diane Hsieh is absolutely right about our choices to be rational even in the face of emotions and cravings. It is a recurring struggle for me which is happening at more and more infrequent intervals, thankfully.

  46. Got your book free (thank you) and read it all. I have been doing low carb (my elephant is mostly under control) for the past 11 years and will be turning 59 next week. My cholesterol is 303, triglycerides 68, and HDL 111 and I am 5′ 4″ 130 pounds. I started Niaspan about 4 months ago – 1500 mg. I have been taking the magnesium you recommended for the past 3 weeks and have stopped having the spastic bladder urgency problems. Woo Hoo!

    Two questions – What to do about cholesterol numbers?

    Does my husband need to take calcium with his magnesium

    Most of your cholesterol is HDL, the good kind, so who cares?

    I don’t know anything about your husband’s medical history, so I couldn’t possibly comment on his supplement regimen.

  47. Hi Doc,
    You know that the elephant and the rider analogy is far from new, and is often mentioned in the Indian Buddhist texts. The idea goes roughly thus: the elephant can be directed to go this way and that by the driver (called the mahout), but the elephant can go its own way and ignore the mahout’s directions. But the skilled mahout is able to use the elephant hook, a small implement that gently touches various nerves in the base of the beast’s head and this more forceful method, more forceful than just the mahout using his knees on the elephant’s neck, can bring the elephant’s attention back to the directions of the rider. The elephant hook here is mindfulness — i.e. an awareness that the elephant-mind is ignoring you, the mahout. And so forth.
    And yes, I’ve got an annecdote from my time in India. In ’79, an American translator of Tibetan stuff and academic was visiting us, and indeed collaborating with a group of us (a book resulted) and he and his umpteen children and Mrs had had a bit of a shock. They were visiting Bodhgaya, and did the usual family thing of riding an elephant in a howdah, the platform on top of the elephant’s back. Well, the next day after their ride, when the very same elephant was carrying another lot in the howdah something went wrong and the elephant went rogue. She tried to wriggle the howdah off by standing on her back legs and trying to push the strap off her waist. The poor unfortunates in the howdah perhaps survived (I think, I wasn’t there), but only because of the skill of the mahout, who applied his elephant hook to the special place, known only to mahouts, at the base of the skull that instantly killed the poor beast.
    That’s why many of the Buddhist tantric deities hold the implement of the elephant hook: it’s reminder that you are the mahout and not to let the elephant mind rule you.
    My point: this stuff is not new, and I don’t want to make any religious point-scoring or cause any divisveness like the last time I mentioned Tibetan stuff. My kids have Tibetan cousins and this culture is an important part of the Richards family. OK?

    Michael Richards

    The author of the Happiness Hypothesis states that the elephant/rider idea is from Buddhist texts. He’s not trying to take credit for coming up with it – just making available for public consumption.

    Thanks for the explanation of the mahout and the elephant hook. That’s what those of us need when dieting and our elephant goes nuts: an elephant hook to bring it around. Maybe that should be the title of our next diet book: how to hook your elephant.

    Cheers

  48. One thing I also forgot to mention and don’t know if it applies here but after trying for decades to quit smoking and developing a mild gambling addiction in my later life, once I started low-carbing I got off the smokes completely, no cravings, and I couldn’t care less about gambling. Sure we can try and blame low-carbing on all the good things in our life, but I’m quite sure personally that it really helped with my addictive behaviour once my body was getting what it needed.

  49. Just a few thoughts for those who have a difficult time resisting carb offerings. I like to think of it in terms of caring about myself. A number of years ago, I thought to myself, what would I choose to do if someone were offering doughnuts to my diabetic child? Would I just go along and let her have them because we didn’t want to offend the host or the client or my relatives? My answer was obviously, “No,” so why would I not treat myself with the same degree of care and attention? Also, if we make and keep commitments to others, why don’t we keep the committments that we make to ourselves? It does take practice to get to a point where we act in our own best interests without feeling deprived. Sometimes we need to come up with scripted responses ahead of time. Of course the simplest is “No, thank you,” but others can be sort of breezy, like “Ohhh, I’d love to, but I just can’t!” Which brings me to another observation that I’ve made and that is that people have some idea that fat people should accept any food that is offered, no matter what, and if they don’t go along, it’s an insult. No allowances are made for food preferences, or allergies, or health needs. If a fat person turns down food, the response, after the initial huff, is usually something like, “Aw, c’mon, it won’t hurt you,” or “But I made this just for you!” And we’re so conditioned to not offend that we acquiesce. Conversely, I’ve noticed that many a hostess won’t even attempt to offer certain foods to thin people, or when turned down, don’t press it on them, no cajoling, no questions asked. Anyway, as this post says, we really need to reclaim the control of our food choices. We can change our views to see that eating a certain way is not punishment or deprivation, but health-building, and focus on nurturing ourselves as we would a loved one. And no, it isn’t easy or simple, but it’s worth it.

    Good points all. Thanks for posting.

  50. LynP,

    I highly suggest some time reading at Jenny’s BloodSugar101.com website.

    Agreed, also have a look round almost any diabetic forum or newsgroup (even the ADA Forum, IMO the best part of their site) if you want more support and success stories from people who are almost all singing from the same hymn sheet.

    Look at it this way, we routinely see people making huge improvements like for example bringing their A1c from 11.1 to 6.9 which are almost unknown in the “literature” where papers crow about how drug A is far superior to drug B because it reduced A1c by 1.5% instead of 1%

    IOW you were doing extremely well already before the illness came along followed by the steroids, both of which annoyed the hell out of the elephant and both of which jack up BG (some people use insulin temporarily to cover steroids)

    You have another 1000 mg of metformin available before you are on maximum dose. Personally I find Alpha Lipoic Acid 150 mg x 2/day tames my overractive liver. Both work synergistically with exercise on reducing IR, as does reducing BG in itself.

    Treat this as a temporary setback, the elephant is starting to calm down now after having a tantrum. It took time to get into the state you’re in and in will take time to get out of it again, you’re doing all the right things. Tickle it behind the ears, they like that.

    This time next year you’ll be another 50 lbs down and you’ll be like me, freaking out because my BG is about 10 points up overall and I just hit 130 after a meal which shouldn’t have put me over 110 and wondering if it’s the sinus infection from hell come back at me or if I’m sickening for some other winter infection. Perhaps I should have washed that doctor before I touched her

  51. Thanks Doc! OK, because my liver cells are minimally responsive to insulin, they are ‘happily’ churning out sugar…lovely. So my conviction that insulin is not the right choice for me now is right? That more insulin will just result in the same or more resistance even IF my BG falls and I get fatter? My BG will fall to pre-meal level but it takes about 4 hrs. My morning BGs are always within 5 pts of my bedtime BG, although I have had unpredictable drops of 20 pts. So far, exercise seems to be the only thing that drops the BG…well, that and the metformin.

    Got any suggestions that might help/support my liver as I continue to lose wt (2 #s overnight hurrah); this is gonna be a long process (mom’s diet while preggers probably set the trigger on the loaded gun that my grandmom’s and great grandmom’s diabetes provided *sigh* mom has normal BGs). Milk thistle? Would increasing metformin to 2K mgms (from 1500) help reduce the production of glucose (or is 500 more mgms just not enough ‘braking’ power)? How ’bout the insulin mimetics? Do they act differently enough (chemical pathways) to provide some ‘braking’ of this let’s produce tons of glucose?

    RANT: why didn’t any doc tell me that my ’77 GTT (80-160[20 mins]-58[25 mins]-62-58-62-58-62-58-62-58-62-58…yes it went on that long, they finally gave me some kefir and sent me home before 5 PM traffic) revealed hyperinsulinemia & that I was already on my way to becoming diabetic because of my distorted response to carbs? They said small amts of carbs every hr or so would keep my hypoglycemia from being more a problem than a nusiance–that suggestion made it much worse. I’ve eaten lower carb since but obviously not low enough. I’d have eaten much differently & exercised a lot more if I’d known then what I know now. Ahh, ignorance, theirs and mine *sigh* and now I pay the price for how I’ve eaten since then.

    Thanks for the tip, Anna, I just found her website this past wk.

    One of the supplements I always give my diabetic patients is alpha lipoic acid. I usually start them on 300 mg per day and work down to 100 mg per day after several months.

  52. To Halle, I always talk to my inviting host/hostess about the menu & mention that I eat very few carbohydrates and volunteer to bring something that I know I can eat: cold shrimp with horseradish-sour cream for me and the expected cocktail sauce for others, cheese/veggie trays, olives, deviled eggs, crustless quiche. I have been known to eat ahead of time, then eat very small portions of whatever’s safe at ‘their’ house. I also suggest pot lucks and take entrees that most would also enjoy (meatloaf stuffed peppers is easy…just increase the veggies & don’t add rice/bread). Eating out is not usually a problem as most restaurants have something that’s OK to order; even Italian has some sort of safe chicken with salad. We ate out at Outback this afternoon: the 6 oz sirloin special with salad (I order dressing on the side & usually skip it) & mixed veggies, the others had dessert while I had coffee.

    Thanks for bringing this up. Eating before you go out – the right foods, of course – often can help in keeping grazing to a minimum while out.

  53. Hey Doc, somewhere in one of your blogs you responded that some of your diabetic patients who couldn’t their BGs down finally did so when they went to an all-meat (all protein?) eating plan. Would this help with the liver insulin resistance? Or is the extra protein just gonna be converted to more glucose?

    Is there anything one should supplement with when eliminating veggies? Probiotics? I’m already on a 500 mg Quercitin+buffered C 1K supp and take another 1K buffered C later in day since I read a wk ago that glucose competes with C.

    Sorry for all the questions…they just keep occurring (I hope someone else reading these is as inspired as I’ve been reading the responses).

    It could help with liver resistance. The extra protein is only converted to glucose if you need extra glucose. Otherwise it is burned just like any other macronutrient.

    If you get rid of veggies and replace them with meat, why do you need any kind of supplement other than just a regular daily vitamin (if even that)? Meat is much more nutrient dense than any vegetables.

  54. Hi there, Dr. Mike.

    Thank you so much for writing this. It has opened my eyes to a lot of things, especially the fact that even though life happens, I don’t have to give in to temptation. I tend to use that as a crutch or excuse to run to the cookies.

    Funny thing: I posted a link to your article on a low carb forum site that I’m a member of. The response I got from one guy aggrivated me. He made a comment about how this is just another attempt to say it’s our fault we are heavy instead of our weight being a metabolic disorder, so to speak. You know what? I say that is bull. Each of us needs to learn to control what goes in our mouth. I think he just didn’t want to take the blame on himself for his actions.

    I am finally back in the groove with my low carb plan. I’ve learned to walk by the cookies and the candy bars and just keep on truckin’. I’m not saying I’ll never mess up. No one is perfect. But if I do, I have only myself to blame. Personally, I am through with making excuses and ready to move on to higher ground.

    Thank you once again for a very enlightening article!

    ~Carol Ann

    I’m glad you enjoyed the post.

  55. Hey Doc:

    Just a quick note to say thanks!

    This post shaped the content of a class I taught to Catholic adults today on the topic of sin. I used a real donut to explain your practical advise on how to avoid “near occasion’s of sin” and that deadly sin, gluttony. At least in this case, religion and science seem completely compatible.

    In addition, I took advantage of your Christmas gift of a free copy of PP Life Plan last year and re-gifted it to my sister. Her family embraced the life plan and as a result they have been transformed. My brother-in-law, who is quite buff now, called me this weekend to share how excited he was after his physical last week. His health (including his Lipid panel) was perfect!

    Please know that while the nutritional establishment may not “get it”, many lives are being changed because of your message. Thanks for giving. I for one am grateful.

    Thanks for the kind words. I truly appreciate them.

  56. Sorry Doc for all the posts (combine or delete as you see fit)! I just watched “60 Minutes” with a segment on Sirtis Pharmaceuticals and their research on resveratrol; the info re lowered glucose was astonishing. Then, I went online for more info. OK, at 2.5 gms twice daily, great effects for Type 2s . Then, I read where Biotiva actually delivers what the label claims. Then, I read that their product TransMax contains no Quercetin which they claim “blocks the recirculation of important resveratrol metabolites and inhibits SirT gene activation” — whoa! I just switched to a Quercetin+buffered C supp. Then, I read that Quercetin has been shown in some studies to lower BG & has other protective effects for Type 2s. This is getting confusing. Then, I read this (ScienceDaily (Oct. 4, 2007): “the researchers report that SIRT1 levels are reduced in insulin-resistant cells and tissues and that treatments that block the enzyme’s function lead to insulin resistance. Furthermore, increased SIRT1 activity improved insulin sensitivity. Similarly, resveratrol–at a dose of just 2.5 mg/kg/day–enhanced insulin sensitivity in cells. That low dose of resveratrol also reduced insulin resistance in animals fed a high-fat diet, the researchers showed.
    “We found SIRT1 improves insulin sensitivity, especially under insulin-resistant conditions,” Zhai said. “Furthermore, we found that resveratrol, at a very low dose compared with many previous studies, improves insulin sensitivity via SIRT1.”

    The apparent study results on BG for resveratrol > than those for Quercetin — but do we know enough about resveratrol to start taking it? Why the heck didn’t they study it feeding a high carb diet? Sure sounds promising & that last bit makes me think I should drop the Quercetin & go back to my buffered bioascorbate.

    Oh, anyone else heard that the maltodextrin used in the powdered Splenda tests high on your meter? I tried it this morning after overnight reading & before eating: on decaff “lo”, 140 with 1 pkg Splenda…yikes! I call my meter’s tech crew & ask them…they have no info as to whether the sugar-base of Splenda is being read or whether Splenda itself or its maltodextrin was responsible for that reading. I drank the decaff anyway, didn’t eat anything & 30 mins later I had a rise of 11 pts, 45 mins later before b’fast BG dropped 18 pts — this is bizarre. Have avoided Splenda all day, kept carbs to <6/meal, & BG has continued to drop all day to today’s low of 134; am going to avoid Splenda for the next several days & see what happens. I must admit that I also feel less sick than I have the past few days so that might be responsible. I understand that liquid Splenda has no maltodextin so I will hunt for it & give it a try.

    Thanks all for your suggestions. I will try the r-isomer alpha lipoic another try…my gut didn’t like it before but that was several yrs ago. I use an alpha lipoic-gn tea face cream that’s kept me outta my Derm’s office for sun-damage for the past decade…no more actinic keritoses.

    “Tickle it behind the ears, they like that.” — I’ll try that, my body’s been thru massive changes since I began this medical odyssey Aug07 that’s for sure. More chocolate….hmmm, nothing but powdered Splenda…would a bit of vanilla extract work? Must experiment.

    Don’t get too excited about the resveratrol. All these experiments you’re quoting are rodent experiments. No one really knows yet if it works that way in humans.

    Interesting observation about Splenda. Please let me know what your readings are when you try the liquid variety. My bet is that it is the maltodextrin.

  57. My “elephant hook” is the BG meter, it provides instant feedback on the difference between NORMAL levels of carbs and TOXIC levels of carbs (perhaps that’s the way it should be presented)

    IMO there is a strong case for loaning all newly diagnosed diabetics a CGMS. This would probably be even more useful for “prediabetics”, metabolic syndrome and even nondiabetic obesity in demonstrating the BG changes which annoy and damage the elephant, and head off the progression before it becomes irreversible

    Even better might be some cheap means of measuring actual insulin levels

  58. Please forgive the off-topic questions. I just purchased some magnesium malate and the pills are HUGE. I can’t swallow them. Is it ok to mash them up for consumption or is there a reason why this might not be a good thing to do? I was thinking of throwing them into a protein shake. I have the same problem with some fish oil capsules. I did buy some liquid fish oil to take with a spoon, but I’d hate to have to discard the capsules if I can just squeeze out the contents. Thanks!

    No reason you couldn’t crush them and add them to a shake other than taste. And I doubt if you could even taste them. Give it a try.

  59. As everyone else has said, you are a wonderful writer.

    Re my own elephant, it can usually be distracted. Last night I desperately — desperately — wanted to buy cookies & milk on the way home. So I treated myself to a “fattening” In-N-Out burger (protein style, of course). It was fantastic, the elephant went to sleep, and this morning I’m down another pound and a half.

    Good for you. Keep after it. Take your victories one at a time and revel in them.

  60. I’ve been thinking about elephants (and other animals) who go rogue and rebel, and it seems that there is nearly always a reason for it rather than the animal just suddenly losing it’s mind (abuse, confinement, deprivation, forcing it to do something against its nature, for example). For us, I think our elephants go rogue when we’ve pushed them to the same point of rebellion, perhaps by attempting some of the same harsh tactics (too few calories, too little fat, no variety, getting too hungry); then, it’s just the extra stress (Mom in the hospital) that proves to be the last straw.

  61. Very OT, from Bloomberg today:

    “Pfizer’s $68 Billion Wyeth Deal Eases Lipitor Loss

    ” … The acquisition will be financed by Bank of America Corp., Barclays Plc, Citigroup Inc., Goldman Sachs Group Inc., and JPMorgan Chase & Co., Pfizer said. Morgan Stanley and Evercore Partners Inc. are counseling Wyeth. Each bank will put in $4.5 billion.”

    Your TARP … er, tax … dollars at work.

  62. Hi Michael,

    I had an interesting experience recently that I thought I’d comment on since it follows up on a post you made a while ago about sugar addiction (although in this case there is no sugar).

    I have been on a strict low-carb diet for the last 6 months… no more than 20-50g a day, usually around the 20g per day.

    Last week I thought I’d reward myself for how much progress I’d made with a Coke Zero. I know it has no sugar at all, but I typically would never touch the stuff as I’m not sure how healthy it is and I don’t want to risk last does or artificial sweeteners. Anyway, I had a 1.5 liter bottle in 2 days… and loved it!

    What amazes me is that I immediately had strong cravings for more. After a 5 days I got another bottle rationalizing it won’t affect my sugar intake. I’ve just finished it last night and I feel the surge of addiction. Amazing to me that I crave it so much!

    Anyway, I’m not getting another bottle for a long time… but this amazes me. It’s not even the sugar… either the sweetness… or something else.

    No wonder Coke has such a huge business!

    Do you know how this type of “addiction” could work? I presume it’s all in my brain since I wouldn’t expect hormone levels of any kind to change dramatically when drinking Coke Zero when compared to my usually drink, water. I wouldn’t buy the theory that’s it’s “psychological”… I agree with many of the things in this current post of yous.. but there is definitely some biological mechanism at work here than has to do with the brain and/or body rather than “mind”.

    Michael

    When the mouth tastes sweet or even if the nose smells sweet (as in the aroma of fresh bread baking) the pancreas releases a tiny squirt of insulin in anticipation of the incoming carb load. This small release of insulin is called the ‘first phase response.’ The body is trying to stay a little ahead of the game instead of waiting until the carbs actually get there before dealing with them. If you really eat the carbs, there is no problem. But if all that comes on board is a bunch of non-caloric beverage, then the little bit of insulin has nothing to work on, so reduces your blood sugar instead. A falling blood sugar is a strong stimulus to eat, and typically a strong stimulus to eat carbs, which is the quickest way to get the blood sugar back up. It’s all just physiology at work.

    If you drank the Coke Zero and had a little something to eat at the same time, you probably wouldn’t have the craving response because your blood sugar wouldn’t drop. Try it and see.

  63. Hello Dr. Mike –

    Thank you for the free copy of Protein Power Lifeplan! I’m aware, thanks to this blog, of a couple topics where your current recommendations are different from those you presented in PPLP (i.e. Vitamin D). While we eagerly await the release of your new book, would you be willing to post something on your current supplementation recommendations vs. those you presented in “Micronutrient Roundup” (in the Appendix of PPLP)? Especially, do you have a recommendation for daily intake of krill oil (or specifically EPA and DHA)?

    Thank you (that’s plural, including MD) for your attention and for all your work. In the last 12 months I’ve gone from an almost-obese (26+% body fat) 51 year old man , to a 52 year old man carrying 17% body fat. The plural of anecdote is NOT data, I know, but I’m convinced!

    Pete

  64. Unrelated to your post here, Dr. Eades, but wanted to share this link I bumped into today:

    HFCS found contain mercury, according to the WaPo
    http://www.washingtonpost.com/wp-dyn/content/article/2009/01/26/AR2009012601831.html

    I admit I haven’t dug into this more, but yikes at the surface value anyway.

    get ready for the inevitable spin from the corn industry.

    I’ve always heard a lot of lobbying, etc. went into t he current “safe” consumption levels of tuna for nursing/pregnant moms and young children. I wonder how fabulous it is now when they have their tuna (with HFCS containing mayo) and their soft drink.

    Just one more reason to spend more time in your own kitchen. Thanks for the link.

  65. Hi Doctor,

    I’m vacationing at the moment. At night i’ve been drinking a bit more brandy and rye than usual. Also, my mixer of choice has been 7up Free, meaning 0 carbs. Since i don’t have your books on hand, i’m trying to recally your view on aspartame, which is used in 7up Free. I can’t remember whether it is okay to consume or if is causes high blood sugar and/or insulin resistance.

    I’m not a big fan of aspartame, but not because it causes high blood sugar or insulin resistance, because, as far as I know, it doesn’t. But it does cause short term memory loss in some people and headaches and abdominal pains in others. You can enter aspartame in the search function of this blog and find a more comprehensive explanation of my thoughts on the substance.

  66. Hello, Doctor . I know this question is off topic but ive been following a low carb diet for some time now. I have had great success with it. I reccomend your book regularly as one of the best books on nutrition i have read as of yet. I have alot of respect for you. I have a serious question though of which i cannot find the answer. I eat alot of fish on my low carbplan. I have recently been investigating the link between fish and stomach cancer risk. It dosent seem apparent at first. But if you look deeeper there appears to be a linK. All the countries with the highest consumption of fish have the highest rates of stomach cancer. Japan, China, iceland, korea and the eskimo. Now is it the preserved and salted fish or the fresh fish or fish in general? Do you think it is the salt? Or other factors? This worries me quite a bit. There is obviosly something there. What is your view? Thank you have a good day.

    I wouldn’t worry about it all that much. The data you describe all originates from observational studies, and, as a consequence, can’t be used to prove causality. The increased rates of stomach cancer in these various countries may or may not have anything whatsoever to do with fish consumption. The Japanese have the greatest longevity of all the societies studied, so you could equally make the case that fish consumption leads to longevity.

  67. I find it interesting that many respond to extra stress by abandoning good eating habits. I have been eating a low carb diet for over 6 years, and in that time have experienced a considerable amount of severe stress on a number of fronts. People often comment on how calm I remain in the face of it. It helps me to know that I have total control over what I eat, while I can’t really change any of the bad stuff. I firmly believe that keeping as physically healthy as possible with good nutrition and exercise helps to keep me mentally strong as well. I can respond to stressful situations without totally going to pieces—although I often wonder what that would look like! Maybe it matters that I had already adapted my eating habits by the time the first crisis hit. I wasn’t trying to learn something new, but just continue what I had committed to and felt comfortable with.

  68. Wow…thanks for this post. This is exactly where I’ve been for a couple months. I went completely vegetarian a couple months ago, and it’s been a disaster…I’ve gained back about 25 pounds of the 70 I had lost. I’ve been in exactly that place the past few weeks–making promises to myself at night, then waking up in the morning and going back to the same thing. Eating low-carb can be a challenge at times, but eating vegetarian (even when I’ve been really diligent about it) has been almost impossible. Even when I’m full, I’m never satisfied, and I end up eating something sugary. I’m back on track today (I’ve started the day with a low-carb protein shake, and I’ll probably go for something grilled for lunch). I first bought your book in the mid ’90’s, and when I follow the program, it’s great. I need to stop over-thinking the whole thing and just let it do its job.

    Seeing this post has genuinely been a life-saver. Thank you.

    I’m glad it helped.

  69. One of the supplements I always give my diabetic patients is alpha lipoic acid. I usually start them on 300 mg per day and work down to 100 mg per day after several months.

    Just curious, in newsgroups and forums there appear to be responders and non-responders, do you see that in practice and is it related to other meds they may also be taking? I have a suspicion that if you’re already taking metformin it doesn’t have any extra benefit. Either that or it only affects certain individuals’ IR and not others and most of the ones it doesn’t affect are already on met or a TZD?

    Another one that got caught in the spam filter. ALA performs a multitude of beneficial duties. It helps with carb metabolism, it is an water and fat soluble anti-oxidant, it stabilizes one of the main inflammatory factors, it chelates heavy metals, it reverses diabetic neuropathy and it helps get glucose into the cells. It is only this last activity that might also be performed by metformin. I’ve seen pretty good results with ALA, and although metformin is my drug of choice if I have to give a drug for blood sugar elevation, I’ve had such good luch resolving blood sugar problems with diet, that I haven’t had a lot of patients on both metformin and ALA.

  70. I wouldn’t worry about it all that much. The data you describe all originates from observational studies, and, as a consequence, can’t be used to prove causality. The increased rates of stomach cancer in these various countries may or may not have anything whatsoever to do with fish consumption. The Japanese have the greatest longevity of all the societies studied, so you could equally make the case that fish consumption leads to longevity.

    Heh, good point! Maybe the fish stops you dying of cardiovascular disease so since you have to die of something (believe it or not) it lines you up for cancer instead . . .

  71. What about actual physical discomfort? I tried Atkins several years ago and lost about 50 lbs in 6 months. Once I stopped being strict the weight came back on until now I am 15 lbs heavier than when I started.

    Whenever I try to go back on a low carb diet it is not cravings that get me, but I begin to feel increasingly uncomfortable until I start to feel physical pain in my stomach. I also have increasingly powerfull hunger pains that meat and vegtables don’t put a dent in.

    Do I just need to hang in there for weeks before that will go away? I am not sure I can do that.

    I’ve never had this question presented to me. I don’t know what to tell you. Maybne other readers have suggestions.

  72. I get the exact opposite, low carbing removes the cravings and hunger pangs, which is the commoner reaction.

    See if you can get a hold of a BG meter, the symptoms may be associated with BG lows or rapid drops, and checking for ketones at the time may also be a plan. In my case it was the rapid BG drops following on from excess carbs causing postprandial spikes which set off the gnawing hungers

    Otherwise it is possible something in your diet is affecting you in a different way, eg. IBS or GERD, which is not being triggered by the high carb diet (no-one said you are only allowed one illness at a time!)

  73. OK, too much fat…will stick to the lower fat cheeses & cut amts of nuts. My BGs are improving daily, only one >140 in the past 4 days — hurrah. This cutting carbs to <8 per meal/snack is working…oh, exercise helps *G*! Dropped Januvia from horrible side effects (BGs went up as expected, 3 wks & a whole bunch fewer carbs later back down), nearly over the asthmatic bronchitis (rescue inhaler down to once/wk or so in the ‘artic’ chill…we Southerners don’t like y’all’s cold, Northerners, take it back, please please please), dropped Cozaar to half dose and BP remains stable. Will tackle eating less fat and see if that stops the lose-gain-lose cycle, so I can just lose and get off the rest of the Rxs.

    Powered Splenda tested at 140…as I wrote before, yikes!

    Spenda with Fiber (sucralose + soluble corn fiber) tests at 43. Bulkier than Splenda, no discernible taste or texture.

    Organic Zero (erythitol fermented from organic sugar cane juice) tests at ‘lo’. This has only 70% of the sweetening power of sugar, but it looks exactly like sugar (I’ll never put it in a container, I might forget *G*). Yes, it’s an -itol but it’s metabolized differently so that it is pretty much gone before it hits the part of the gut typically results in the ‘trots’…no problem for me and I’m pretty sensitive to -itols. At one pkg, I can’t discern a texture or taste but I did with 2 (in my hot cocoa) so I use the Splenda w Fiber in my hot cocoa. Oh, it’s expensive. Cargil used to market their eythitol as “Eridex.” Other mfg market it too.

    Diabetes educator called after seeing my emailed BG log & notes re dropping Januvia and gave me the lecture that my monitor is not intended to ‘read’ these ‘sugars’…yeah yeah yeah (the tech guys haven’t replied yet), well if my monitor gives me a number and it’s higher than what my BGs should be as I told her & it causes a rise in my BG, then it’s not going in my mouth. Let somebody with better glucose control eat it *G*.

  74. ” If someone had told you they were going to shoot you if you ate one of the donuts, you wouldn’t have eaten it.”

    Ok, I was with you until this part. Now you seem to be advocating arming Doctors with guns to force us to lose weight?

    The rebellious part of me is saying “Eat some tacos” and the emotional self is saying “eat some cake” and the trusting part of me (who is feeling very betrayed right now) is saying “Eat some cake tacos and wash it down with a 2 liter of Pepsi”.

    In all seriousness, this reminds me of the Big Mind Big Heart process a bit. We are made up of many selves all with their own jobs. Maybe we also need to make piece with the self whose job it is to get us to eat lots of food?

  75. “Ok, I was with you until this part. Now you seem to be advocating arming Doctors with guns to force us to lose weight?”

    According to today’s Parade magazine supplement in my local newspaper, governments are already finding ways to influence peoples’ weight and waistline – gun-toting doctors probably won’t be needed just yet, because government knows what’s good for its citizens, right?

    The article lists a number of countries that already have programs in place, or plan to institute programs soon. For instance, health officials in Japan check the waistlines of those over 40 yoa, and diet counseling is the reward for too much “tape”. Restrictions are in place against fat people immigrating to NZ. Some UK cities are recruiting people to wear electronic tracking tags to monitor movement and calories burned, with store coupons and days off work as rewards for exercising. NHS already pays for 30,000+ people to take weight loss classes.

    Germany is going all out, spending $47 million on “healthy” eating and sports programs; enacting “tougher” school lunch standards (my guess is they’ll probably emphasize low fat – there goes whatever good traditional German cuisine remained in kid’s lunches); the German gov’t is also requesting candy makers to not target young children (guess parents have no role anymore) and they want software companies to make games that force players to move (I can see it now, Aerobic PacMan).

    At the end, Parade Magazine asks readers, “Does the US need a government-backed effort to end obesity”. Vote at parade.com/intel.

    My vote will be no, the US government has done enough damage already, thank you very much.

  76. I can understand where the person who had to put mom in the hospital is coming from. Chances are, she was away from home and her kitchen a lot while all this was going on. She had to make due with what she could find where she was. The elephant for those of us doing low-carb are all those habits we have built up over all these years about what to eat and where to find it. It takes time and attention to retrain the mind to think in terms of low-carb. When other things come up that grab time and attention, it is just easier to let some things go on “auto-pilot” or turn them over to the elephant, so to speak. The best way to prepare for such things is to have a plan. What do you do when time is short and you’re really hungry? What do you do when you’re nowhere near your kitchen and it’s dinner time? What do you reach for and where will you find it? These decisions need to be made ahead of time and rehearsed in the mind over and over again. Hypnosis can help with the rehearsal part and make those plans feel natural.