I receive occasional emails and comments from people who can’t believe wheat isn’t health food. Some have quoted Bible passages about our daily bread, the staff of life, breaking bread with family, etc. Others have pointed out that Americans ate plenty of bread and other wheat products 100 years ago, but weren’t as likely to be fat and diabetic as people today.

I usually reply that the wheat products we consume today aren’t the same as those consumed by people in Biblical times, or even in more recent times. But I didn’t realize just how different today’s wheat is until I read Wheat Belly, a terrific new book by Dr. William Davis, the cardiologist you may already know from his Heart Scan Blog.

The title, of course, refers to the big gut that so many people today are carrying around in front of them these days.  While he’s no fan of sugar or other refined carbohydrates, Dr. Davis believes wheat is a primary (if not the primary) driver of the rise in obesity we’ve witnessed in the past quarter century, and he makes a strong case for that belief.   But getting fat is hardly the only price we pay for our love of bagels, breads, cereals and muffins. As Dr. Davis explains in the book’s introduction:

While much of the Wheat Belly story is about overweight, it is also about the complex and not fully understood range of diseases that have resulted from it – from celiac disease, the devastating intestinal disease that develops from exposure to wheat gluten, to an assortment of neurological disorders, curious rashes, and the paralyzing effects of schizophrenia. Documented peculiar effects of wheat on humans include appetite stimulation, exposure to brain-active exorphins (the counterpart of internally derived endorphins), exaggerated blood-sugar surges that trigger cycles of satiety alternating with increased appetite, the process of glycation that underlies diseases and aging, inflammatory and pH effects that erode cartilage and damage bone, and activation of disordered immune responses.

And later, in Part One:

There’s hardly a single organ system that is not in some way affected by wheat products. The health impact of Triticum aestivum, common bread wheat and its genetic brethren, ranges far and wide, with curious effects from mouth to anus, brain to pancreas, Appalachian housewife to Wall Street arbitrageur. If it sounds crazy, bear with me. I make these claims with a clear, wheat-free conscience.

In the rest of the book, Dr. Davis back up those claims. He delves into quite a bit of nutrition science and some biochemistry, but writes in a clear (and often humorous) style that makes for easy reading. As a doctor who’s treated thousands of patients, he has the added advantage of being able to cite case histories from his own practice – patients who came to him unknowingly damaged by wheat, but were cured by wheat-free diets.

One patient, a thirty-eight-year-old woman, was told by her doctor that she’d have to have part of her colon removed and replaced with an external bag. After Dr. Davis talked her into going wheat free, her colon healed itself. Another patient, a twenty-six-year-old man, was experiencing so much pain in his joints, he could barely walk. Three different rheumatologists failed to identify a cause. When he visited Dr. Davis for a heart condition, Dr. Davis suggested he try a wheat-free diet for the joint pain. Three months later, the young man strode into the office pain-free and reported he’d been jogging short distances and playing basketball. His heart condition had cleared up as well.

Before the chapters detailing the many ways wheat can damage our bodies and brains, Dr. Davis begins by recounting the history of wheat itself. It’s a fascinating story — in a Stephen King sort of way, that is. Here are a few quotes from that chapter, which is titled Not Your Grandma’s Muffins: The Creation of Modern Wheat.

Bread and other foods made from wheat have sustained humans for centuries, but the wheat of our ancestors is not the same as modern commercial wheat that reaches your breakfast, lunch and dinner table. From the original strains of wild grass harvested by early humans, wheat has exploded to more than 25,000 varieties, virtually all of them the result of human intervention.

The first wild, then cultivated, wheat was einkorn, the great-granddaddy of all subsequent wheat. Einkorn has the simplest genetic code of all wheat, containing only 14 chromosomes.

Shortly after the cultivation of the first einkorn plant, the emmer variety of wheat, the natural offspring of parents einkorn and an unrelated wild grass, Aegilops speltvoides or goatgrass, made its appearance in the Middle East. Goatgrass added its genetic code to that of einkorn, resulting in the more complex twenty-eight-chromosome emmer wheat.

Emmer wheat, Dr. Davis explains, was probably the wheat of biblical times. Later the emmer wheat mated naturally with another grass and produced Triticum aestivum, the forty-two-chromosome wheat that humans consumed for centuries – right up until the past 50 years or so. That’s when the story of wheat becomes a bit of a modern Frankenstein tale.

Like Dr. Frankenstein, the scientists who created today’s wheat had good intentions: the goal was to produce more wheat per acre in a shorter span of time, thus vastly increasing yields and preventing worldwide starvation as the planet’s population swelled. To that extent, they succeeded. Geneticist Dr. Norman Borlaug, who created the short, stocky, fast-growing “dwarf” wheat most of us consume today, is credited with saving perhaps a billion people from starvation.

The problem is that dwarf wheat varieties were developed through a combination of cross-breeding and gene splicing. The result is a mutant plant with a genetic code that never existed in nature before. In fact, today’s wheat literally can’t survive in a natural setting. Take away the modern pesticides and fertilizers and it’s (pardon the pun) toast.

Perhaps overjoyed at the prospect of the feeding the world, the developers of modern wheat varieties weren’t interested in conducting tests to see if these genetically-modified strains were actually fit for human consumption. Dr. Davis believes they’re not. At the very least, we’re now consuming wheat that’s genetically different from what our ancestors consumed:

Analyses of proteins expressed by a wheat hybrid compared to its two parent strains have demonstrated that while approximately 95 percent of the proteins expressed in the offspring are the same, five percent are unique, found in neither parent. Wheat gluten proteins, in particular, undergo considerable structural change with hybridization. In one hybridization experiment, fourteen new gluten proteins were identified in the offspring that were not present in either parent plant. Moreover, when compared to century-old stains of wheat, modern strains of Triticum aestivum express a higher quantity of genes for gluten proteins that are associated with celiac disease.

Hybridization efforts of the past fifty years have generated numerous additional changes in the gluten-coding genes in Triticum aestivum, most of them purposeful modifications of the “D” genome that confer baking and aesthetic characteristics on flour. It is therefore the the “D” genome of modern Triticum aestivum that, having been the focus of all manner of shenanigans by plant geneticists, has accumulated substantial changes in genetically determined characteristics of gluten proteins.

In other word’s, this ain’t your grandma’s wheat.  Little wonder that when researchers compared blood samples taken from thousand of soldiers 50 years ago to blood samples from today’s soldiers, they found that celiac antibodies are five times more common today among today’s soliders.

Dr. Davis recounts an experiment he conducted on himself to compare the different impacts of ancient wheat and modern wheat on his blood sugar. He managed to find some einkorn wheat and made bread from it. Two slices of that bread raised his blood sugar from 86 mg/dl to 110. Not bad. Then he made bread from modern whole wheat – you know, the stuff the USDA says is the key to great health. Two slices raised his blood sugar from 84 mg/dl to 167. That’s diabetes territory. As Dr. Davis writes in another chapter after explaining the specific types of carbohydrates found in wheat:

Wheat products elevate blood sugar levels more than virtually any other carbohydrate, from beans to candy bars.

As the graph I displayed in a previous post showed, the typical American consumes somewhere around 1,000 calories per day in the form of sugars and grains.  Our dominant grain by far is wheat — wheat that was never part of the human diet until 50 years ago.

The rest of the book details the damage modern wheat can do to our bodies and brains, with plenty of references to both academic studies and case histories from Dr. Davis’ medical practice. He covers the addictive properties of wheat, the effects wheat can produce in our brains (including actual brain damage), and of course the many ways wheat can wreak havoc on our digestive systems. Compared to those chapters, the chapters on skin conditions, accelerated aging, and heart disease seem almost tame. Sure, it’s not good to produce mostly small, dense LDL … but heart disease will kill you later. Untreated celiac disease will make you miserable for life – and most celiac sufferers are never diagnosed.

This is an excellent book, and also an important book. A story a co-worker told me last week illustrates why: his wife suffered from debilitating headaches for years. She went from doctor to doctor, but none could offer an explanation or solution, other than pain medications that basically knocked her out. Then a few months ago, she mentioned the headaches to some acquaintances over dinner. One of them – not a doctor – told her the headaches could be caused by a reaction to wheat gluten and suggested she try a gluten-free diet. She did … and headaches went away.

As my co-worker told me, “I’m glad someone finally gave her the answer, but why did she have to hear this from some Joe Schmoe after years of suffering? Why didn’t any of the doctors we consulted think of that?”

The doctors didn’t think of that because they weren’t trained to think of that. Ask the vast majority of doctors for dietary advice, and they’ll tell you to limit your fats and eat your “healthy whole grains.” They can’t teach what they don’t know.

I hope you all read this book. But more than that, I hope you buy a copy and stick it in your doctor’s hands. The next time a patient shows up suffering from splitting headaches (or irritable bowel, or stomach cramps, or acne, or psoriasis, or depression, or emotional problems, or high triglycerides, or high blood sugar, or arthritis, or asthma), perhaps the doctor will take a careful dietary history and suggest trying a wheat-free diet before reaching for the prescription pad.

Next week I’ll be posting a Q & A with Dr. Davis.  I have a list of questions I want to ask, but if you have questions of your own, post them in a comment.  I’ll pick some to add to my list.

A couple of interesting tidbits about salt and health came my way via Facebook this morning.  Check out the Q & A from this online article:

Q: Isn’t there universal agreement that these low sodium targets are best for everyone?

A: Although most researchers agree that excessively high sodium intake is not good for health, there is disagreement about the ideal level of daily sodium intake. Dr. David McCarron and other researchers from the University of California at Davis and Washington University in St. Louis have questioned the feasibility of aiming for such low sodium intake targets. McCarron and colleagues point out that contrary to popular belief, sodium intake has not increased or decreased during recent decades and that humans naturally consume significantly more than the new recommendations for potentially valid physiological reasons.

It is well-known that sodium is one of the few nutrients for which humans have a “specific appetite,” meaning that if we are low in the nutrient we crave, we seek out foods that provide it. McCarron stresses that when sodium levels in the body drop too low, there are a series of hormonal responses that may have undesirable long-term consequences.

Q: What are some possible negative consequences of excessive reduction of sodium intake?

A: Two studies out of Australia, hot off the press in the journal Diabetes Care, report that for both type 1 and type 2 diabetics, low sodium intake was associated with increased risk of mortality from cardiovascular disease and all other causes. This was not completely surprising because it is known that low sodium intake results in increased insulin resistance. This means that more insulin is needed to stimulate insulin-sensitive cells to remove glucose from the blood. Although these studies do not prove cause and effect, they do stress the need for caution in making sodium recommendations and the need to conduct appropriately controlled human studies.

Another study found that when adults (ages 40 to 65 whose blood pressure exceeded 120 over 80) added vegetable juice containing 480 to 960 mg of sodium to their daily diet, their blood pressure dropped during this 12-week study. This juice also added a similar amount of potassium to their diets.

McCarron points out that worldwide sodium intake varies between about 3,100 and 3,800 mg per day. When sodium intake drops too far below 3,000 mg per day, hormonal changes apparently trigger the drive to seek out food sources of sodium.

Low sodium intake increases insulin resistance?  Have to admit, that was a new one on me.  But here’s a link to a study that came to exactly that conclusion.

Yeah, uh, but, you see, there’s this one tribe in the Amazon where people have a low sodium intake and they’re really, really healthy …

In case you missed it in comments, a reader recommended this documentary about sugar from 1986. I’d never heard of it before, and obviously it wasn’t popular enough when it aired to make much of an impression on the public, considering what’s happened since then.

I was pleased to see Dr. Linus Pauling mention that there’s no correlation across populations between saturated fat intake and heart disease, but there is a correlation between heart disease and sugar. Too bad the anti-fat hysterics weren’t listening. We’ve spent another 25 years since then shooting at the wrong target.

The only place the documentary went off the rails a little was when it got preachy about how many advertisements for sugary foods are directed at kids. Yes, that’s right, kids see a ton of ads for junk foods. But unless I’m missing something here, they don’t respond to those ads by getting in their cars, driving to the store, and spending their hard-earned money on Lucky Charms. Their parents do that for them.

I was also amused when the host announced near the end that new federal rules would soon require food manufacturers to list the amount of sugar and other ingredients on food packages – the implication being that people would respond to the labels by consuming less sugar. Yeah, that worked out really well, didn’t it? Now, of course, the same happy prediction is being made by those who want to force restaurants to display calorie counts. You’d think they would have learned their lesson, but as Milton Friedman once said, in government failure is usually viewed as a justification to do the same thing again, only bigger.

By pure coincidence, I happen to be in the middle of an audiobook narrated by the host of this documentary, John Rubenstein. He’s an excellent reader who can change his voice quite dramatically. He even goes a good version of a rough-and-tough, deep-voiced cop.

Well, you folks have kept the drumbeat going, improving your health, spreading the word about Fat Head and healthy eating, driving the numbers  on Hulu and Netflix, and DVd sales.  All of which gets Tom invited to places like the Ancestral Health Symposium at UCLA to present his “Science for Smart People” speech.

So he’s already gone again and I’m already back again.  You have no one to blame but yourselves.

First, a quick housekeeping note.  It sounds like Tom’s going to be severely out of pocket for the next few days and the comments on the site are already piling up.  In the interest of keeping the dialog here moving, I’m going to approve the ones that I don’t think require his attention.  If you’ve submitted one and don’t see it, please be patient.

I was going to put up a post about some amazing BLT’s The Wife and I make — including low-carb options — along with some hints on bacon and avocados ( I know, add a couple of eggs to the bacon and avocados and you’ve got the whole paleo food pyramid, right?).

But I had an interesting experience this week and I thought I’d share it.  It’s not nutrition or food, but it is about your health, so here goes…

This past Wednesday, being a guy over 50 who generally manages his health by avoiding doctors, I finally went to a new doctor.  It took an hour and a half, which was amazing.

Normally, there’s nothing amazing about spending an hour and a half at the doctor’s office.  In fact, that would generally fall under “completely normal.”

You know the drill.  Get there 15 minutes early so you don’t lose your place, spend 15 minutes refilling out the same paperwork you filled out the last ten times you were there and letting them copy your insurance card again (OMG, you didn’t change insurance companies, did you?  Start over!)

Half an hour after your appointment time, the nurse escorts you back to the exam room and spends five minutes asking you some questions, writing your answers, and taking some measurements (height, weight, blood pressure, etc.).  The nurse disappears and hopefully after only another fifteen minutes or so your doctor comes in and asks you most of the same questions again.  She’ll determine a few tests for the lab to do.  If you’ve got a particular ailment, she’ll probably want a few extra tests.  Then off she goes.

You get escorted to the lab, wait there for fifteen minutes, a tech spends another ten or fifteen minutes drawing blood or whatever needs doing, then back you go.  After another wait — again, fifteen minutes qualifying as a lucky day — your doctor returns, spends up to several minutes reviewing your test results with you, and then tells you that you need to be on statins.  Har!

So what’s so different about spending an hour and a half at my new doctor’s?  Well for starts, I spent the entire hour and a half — brace yourself — with my doctor!  This is him — Dr. Craig Backs

Craig has over 30 years experience as an Internal Medicine Physician, is a past president of the Illinois State Medical Society, and recently returned to private practice after a stint as Chief Medical Officer at Saint John’s Hospital in Springfield. Good person to know.

Almost the entire time was spent with Dr. Backs, except for maybe the first three minutes, which I spent in his reception area, which looks like this…

The seating is comfortable, but this is probably about as crowded as it’s going to get.  More on that in a minute.

And when the nurse came to take me back to the exam room?  Well, that didn’t happen.  He doesn’t have a nurse.  Anything that has anything to do with my medical experience, he does.

Also, we spent the first hour of that hour and a half sitting here:

Since this was my first visit, we spent an hour not only going over my medical history, but also any current complaints (coincidentally, I happened to be having a flare-up of sciatica from old injuries) and my goals regarding maintaining and improving my general health.  We also spent some time on my conviction of the benefits of, and my personal results from moving to the low-carb lifestyle.  With a couple of short detours into politics and economics, of course.

Craig has been a personal friend for years (his son and The Oldest Son went to school with each other from preschool through high school, and remain close friends).  As a result, I’d recommended Gary Taube’s Good Calories, Bad Calories in a social conversation before he started his new practice and he read the whole thing.  Craig is not a low-carb or paleo (or anything else) physician, but he was comfortable with my decisions about nutrition and health.  He’d also support a patient intent on the low-fat approach.  Imagine that — a doctor who wants to help his patients work their way towards their health goals on their patients’ own terms.

After building the foundation of our doctor/patient relationship, we moved into a standard exam room for the actual physical, including all of the usual equipment, although most of them were hooked up so they would load results directly into his laptop and my medical records, which are now all electronic.  This all took most of the other half hour, including some helpful suggestions on addressing the sciatic flare-up.

[It also unfortunately included the usual test for a guy over fifty, which I was not able to get Dr. Backs to waive for an additional fee.  I suppose it's nice to know your doctor has professional integrity, but it's even more important that their hands aren't too big, if you get my drift.  Sorry -- just had to throw that in as a final shout-out to Kenny M -- Tom's vegetrollian stalker!]

In case I come up with another question or problem, in addition to his office number, I’ve got Dr. Back’s email address.  And his cell phone number.  Not because he’s a personal friend, but because he’s my doctor.  When I called to schedule my first appointment, I asked when I could get in.  His office manager asked when would it be most convenient for me?

As I said, none of this occurred because Dr. Backs is a personal friend — it’s all part of his practice that any patient receives.  By now you should be wondering how this could all happen.  The answer is very simple:

Because I pay him.

I know that may sound strange in a society that’s reached a point where most people think that either their employer or the government is responsible for providing health care for them.

Instead, this is how Craig’s practice operates:

I pay an annual fee for his services.  It’s a little more than my cable/internet service bill is for the year, but not enough to be called “concierge health care.”  Craig’s term for it is “personal medicine.”

For that fee, I get my annual checkup and his email and phone numbers.  There’s a nominal fee for additional office visits (probably a polite way to discourage hypochondria overuse) and I pay for any lab work.   I also get a commitment from Craig that he’ll limit the number of clients his practice will accept, probably no more than 500 to start.  I won’t be dealing with nurses, physician assistants, or — under normal circumstances — answering and message services.  When I have a problem or question, I’ll be talking directly to him.  The fee covers kids in the household (up to a certain age), and also any friends or family who are visiting from out of town.

I don’t have to worry that some insurance company is going to tell me I’ve got to pick a new physician because Craig is no longer on the “preferred provider” (low bidder) list.  Or that any tests or treatments Craig suggests are dictated by an insurance company policy manual instead of my doctor’s judgement.

Since I’m paying a decent fee up front, Craig doesn’t have to payroll an entire accounting and clerical staff to code, process, submit and follow up on insurance and government reimbursement claims.  He doesn’t have to wait until the state scratches enough money together to send him some percentage of money he’s due.  He doesn’t have to wonder if the feds are really going to cut his reimbursement rates for seniors by 30 percent next year.  He can also respond and help with many patient issues via email or phone.   This is something many physicians are understandably hesitant to do, because they’re still using their time and putting themselves on the hook for liability concerns, but reimbursement in the insurance systems all center on an office visit.

That reception area will continue to be lightly populated, as it doesn’t have to be sized and used as a revenue queue/holding pen like under the current medical paradigm, where contracts and reimbursement rates mean if the pipeline isn’t full and the doctors aren’t seeing 30 or more patients a day, they’re losing money.  Craig  won’t have to order batteries of tests to give him information that he can instead glean with the time he can now spend with each patient.

I believe that this is to health care what the real and local foods movement is to eating and nutrition.  That is, this is a modern adaptation to get back to the fundamentals that we lost in the march towards bigger, faster, cheaper.  It costs more, but the quality difference is obvious and meaningful.

I’ve always said that although we can all use experts, the bottom line is no one can care about your kids, your money, or your health as much as you can.  Personal medicine is a trifecta.

See you in the comments.

Cheers,

The Older Brother

After a few days of hassling with Final Cut Pro (which I don’t like very much … Adobe Premiere is more user-friendly), I managed to get clear versions of my slides into the video of my speech. So here it is, Science For Smart People, the speech I gave on the low-carb cruise.

Dr. Michael Fox, one of the other speakers on the cruise, told me later he enjoyed the speech very much and thought I should be giving it in medical schools, but was concerned the section about the HERS estrogen trial might needlessly scare women away from taking hormones.  The estrogen women are given today isn’t the same kind used back then.  I asked him to explain on camera, so he did.  I included that interview at the end of the speech.

If you’d like a DVD copy after viewing, you can now order this speech or Big Fat Fiasco (or both) from this page. Since my wife and I are the shipping department, we’ve simplified things by charging a flat $14.99 for either DVD, shipping included, no extra charges for outside the U.S. You can also order both speeches on DVD for $24.99.

(Note to those of you outside the United States: we occasionally receive overseas orders for the Big Fat Fiasco DVD. No need to place that order. If you order the Fat Head international DVD, Big Fat Fiasco is already included as a bonus track.)

Man, oh man.  If only more doctors would stand up and make this statement:

I’m sorry for what the medical establishment has done to people with diabetes.  We’ve done an atrocious job for type 2 diabetics and prediabetics.

We’ve recommended they eat precisely what their bodies can’t handle:  carbohydrates.  We’ve urged them to take poison:  carbohydrates.  We’ve cooperated with the drug companies to encourage diabetics to eat foods that increase drug company profits:  carbohydrates.

Much of the medical establishment’s damage to diabetics has been done innocently, unknowingly.  Rank and file physicians, dieticians and nutritionists put blind faith in their instructors, scientific journal editors, and time-honored and tenured thought-leaders.  Our unquestioning faith has hurt people with diabetes and prediabetes.

Those are the opening paragraphs from Conquer Diabetes and Prediabetes: The Low-Carb Mediterranean Diet, by Dr. Steve Parker.  I’ve been recommending Dr. Bernstein’s Diabetes Solution to anyone who asks me about diet and diabetes, and I’ll continue to do so.  But now I’ll recommend this book as well.

I read quite a few books on nutrition and health, but only urge other people to read those that meet at least one of two criteria:

• Is the information important and not readily available in other books?  (Good Calories, Bad Calories falls into this category.  It’s a tough read, but you won’t find a lot of the information Gary Taubes presents anywhere else.)
• Is the information important and presented in a manner that passes my “Aunt Martha” test?  That is, could we hand this book to our overweight, pre-diabetic, frustrated-with-Weight-Watchers Aunt Martha and reasonably expect that she’d read it and understand it?

Conquer Diabetes & Prediabetes passes the Aunt Martha test with flying colors.  The entire book consists of 190 pages (a sizable chunk of which is taken up by meal plans), so the size of it won’t scare anyone off.  Better yet, Dr. Parker avoids medical mumbo-jumbo and explains diabetes, blood sugar levels, and how carbohydrates affect blood sugar levels in language that’s easy to understand.

As anyone who reads this blog knows, I lost my automatic respect for anyone with an MD or PhD once I began doing research for Fat Head.  Too much bad advice and too many lousy studies have been produced by people with impressive credentials.  As Thomas Sowell (I think) once wrote, credentialed ignorance is still ignorance.  I now ignore the post-graduate degrees and judge what I’m reading based on logic and evidence.

But that’s me.  Like it or not, Aunt Martha and Uncle Joe are more likely to listen to a doctor.  I have friends and relatives who couldn’t quite believe that statins haven’t been shown to reduce heart disease among women, the elderly, or men who don’t have existing heart disease until I handed them books written by Malcolm Kendrick (MD) and Uffe Ravsnkov (MD, PhD).  When Aunt Martha’s doctor or dietician is telling her she needs to stick to a low-fat, high-carb diet to treat her type 2 diabetes, it can only help to have a book written by a doctor who points out exactly why that advice is just plain wrong.  That’s what Dr. Parker does in Conquer Diabetes and Prediabetes.

Although I’m not a diabetic and don’t take any prescription drugs, I was pleased to see the book includes a chapter that lists the drugs prescribed to diabetics and explains exactly what they are, how they work, why they’re prescribed, and what side-effects they may produce.  If Aunt Martha is taking Metformin simply because her doctor said she needs it to keep her blood sugar under control, it would be nice if she actually understood what Metformin does:

Metformin decreases glucose output by the liver.  The liver produces glucose (sugar) either by breaking down glycogen stored there or by manufacturing glucose from smaller molecules and atoms.  The liver then kicks the glucose into the bloodstream for use by other tissues.  Insulin inhibits this function of the liver, thereby keeping blood sugar levels from getting too high.  Metformin improves the effectiveness of insulin in suppressing sugar production.  In other words, it works primarily by decreasing the liver’s production of glucose.

Of course, Dr. Parker’s goal is to control high blood sugar with diet, not drugs – or at least with a lower dose of drugs.  Back in the day, that’s exactly how doctors treated diabetes:  with a change in diet.

In 1797, Dr. John Rollo (a surgeon in the British Royal Artillery) published a book entitled An Account of Two Cases of the Diabetes Mellitus.  He discussed his experience treating a diabetic Army officer, Captain Meredith, with a high-fat, high-meat, low-carbohydrate diet.  Mind you, this was an era devoid of effective drugs therapies for diabetics.

Rollo’s diet led to loss of excess weight, elimination of symptoms such as frequent urination, and reversal of elevated blood and urine sugars.  This makes Dr. Rollo the original low-carb diet doctor.  Many of the leading proponents of low-carb eating over the last two centuries – whether for diet or weight loss – have been physicians.

My, how things have changed.  Now you have medical organizations accusing doctors who prescribe low-carb diets of being quacks and perhaps engaging in mass murder.  I guess that’s why, in a the middle of an excellent book explaining the causes of high blood sugar and how a change in diet can help, Dr. Parker had to include the standard disclaimer that the information he’s presenting shouldn’t be construed as medical advice or medical care.

I’d suggest placing a similar disclaimer on the wall next to most doctors’ medical-school diplomas:  Warning!  None of the dietary advice offered in this office as treatment for diabetes or other diseases should be construed as effective medical care.

The middle chapters detail the diet Dr. Parker recommends, which is actually two diets:  a ketogenic Mediterranean diet intended to be followed for several weeks, followed by a low-carb Mediterranean diet for life.

Personally, I don’t think there’s anything magical about a low-carb Mediterranean diet that makes it a better choice than any other low-carb diet that emphasizes whole foods.  On the other hand, The Mediterranean Diet has been promoted so heavily in the media as a life-saver, perhaps the label will help sell a low-carb diet to people who would otherwise dismiss it as “that crazy Atkins thing.”

As for the standard Mediterranean diet that’s usually recommended, Dr. Parker spells out his objections:

The Mediterranean diet poses a problem for people with diabetes and prediabetes.  It’s relatively high in carbohydrates, which tend to raise blood sugars too high.  The result could be diabetic complications or the need for more and more diabetic medications with unknown long-term side effects.

And a couple of pages later:

Diabetics and prediabetics -– plus many folks with metabolic syndrome -– must remember that their bodies do not, and cannot, handle dietary carbs in a normal, healthy fashion.  In a way, carbs are toxic to them.  Toxicity may lead to amputations, blindness, kidney failure, nerve damage, poor circulation, frequent infections, premature heart attacks and death.

That’s why Dr. Parker created ketogenic and low-carb versions of a Mediterranean diet.  The purpose of the ketogenic phase, he explains, is to lower blood sugar, reduce chronically elevated insulin (or reduce the need for insulin), and re-condition the metabolism to more easily burn fat for fuel.  Many of his patients enjoy the renewed sense of health, weight loss, and better blood-sugar control so much, they decide to remain in the ketogenic phase permanently.

For those who prefer to include more carbs in their diets once the blood-sugar issues are under control, Dr. Parker explains how to slowly re-introduce some extra fruits, nuts, legumes, dairy products and whole grains in the low-carb phase, which is intended to last for life.

After the chapters on how to follow the diets at home, there are chapters on how to eat out and how to deal with cheating –- which is okay once in awhile.  The doctor even admits to indulging in cinnamon buns a couple of times per year.  That’s pretty much how I handle my love of pizza; I give in on very rare occasions.  (Since this is St. Patrick’s Day, I’ll give in to my love of Guinness later tonight.)

There’s also a chapter on exercise that explains what it does and doesn’t accomplish:

Exercise is overrated as a pathway to major weight loss.  Sure, a physically inactive young man with only five or 10 pounds to lose might be able to do it simply by starting an exercise program.  That doesn’t work nearly as well for women.  The problem is that exercise stimulates appetite, so any calories burned by exercise tend to be counteracted by increased food consumption.

On the other hand, exercise is important for diabetics and prediabetics in two respects: 1) it helps in avoidance of overweight, especially after weight loss, and 2) it helps control blood sugar levels by improving insulin resistance, perhaps even bypassing it.

Exercise is good for your health.  That’s why I exercise, even though I don’t believe it’s much of a weight-loss treatment.  But it may serve, at least in part, as a diabetes treatment.

However, as Dr. Parker emphasizes, type 2 diabetes is first and foremost a blood-sugar problem, and diet affects blood sugar more than anything else.  That’s why this is a book that diabetics — and those who want to avoid joining their ranks — need to read.