2019.09.14 Ruth Bader Ginsburg Mural, Washington, DC USA 257 33044 (View on Flickr.com)2019.09.14 Ruth Bader Ginsburg Mural, Washington, DC USA 257 33040 (View on Flickr.com)
2019.09.12 DC People and Places, Washington, DC USA 254 24032 (View on Flickr.com)
This week’s photos were taken in Washington, DC USA (Of course) at a special event featuring CNN’s Don Lemon (@DonLemon), quoted in the title, at the @Newseum, and attended by the leadership and volunteers of @CapitalPrideDC@DCTransPride365.
The occasion was a great one to celebrate and have gratitude for the fact that (a) we’re here (b) we were helped by the courage of the people who came before us, who didn’t look like us or have the same backgrounds as we did, and for me, that the 20th Century was a long time ago, and it’s not coming back.
The 🌎 is an amazing place with people in control of their health and life destinies 🏳️🌈. PS, Isn’t Washington, DC beautiful?
2019.09.12 Rise Up A Conversation with Don Lemon, Washington, DC USA 255 72043 (View on Flickr.com)
The Newseum continues its series of programs celebrating the “Rise Up: Stonewall and the LGBTQ Rights Movement” exhibit with an evening featuring CNN anchor Don Lemon.
The program is the latest in a series of events marking the 50th anniversary of the June 1969 police raid of New York’s Stonewall Inn and the protests that inspired the modern gay liberation movement. The “Rise Up” exhibit explores what happened at Stonewall and how it gave rise to a 50-year fight for civil rights for LGBTQ Americans.
Lemon will discuss media coverage of the gay rights movement from its early days to the present and how media coverage has helped change public views about the LGBTQ community. He will also talk about his own life and career.
2019.09.12 Rise Up A Conversation with Don Lemon, Washington, DC USA 255 72075 (View on Flickr.com)2019.09.12 Rise Up A Conversation with Don Lemon, Washington, DC USA 255 72068 (View on Flickr.com)
Thank you for using yet another photograph as the thumbnail/opener for this video, Nutrition Facts (TW:Nutrition_Facts).
About this photograph, I have to say, wow, it was part of a great moment for me, because it was
Real food, not CRAP – Calorie Rich and Processed Foods – we both agree this is bad!
My dinner for the evening, and it’s true, I wasn’t hungry after
Cooked by people who have achieved metabolic health
Shared with inpiring humans, who can (and do) teach doctors a lot about being better for the people they serve
Shared with incredible doctors, too
Excuse the hard light and shallow depth of field – I was using a fancy camera in a low light / hard light situation.
That’s pulled pork, which is also NOVA Classification Group 1: Unprocessed or minimally processed food(s). The sausage is NOVA Classification group 3: Processed foods. Group 4 is ultra-processed foods – see this post for photos of Group 4 foods (which are plant based…)
As far as I can tell, we’re all maintaining our weight on our real-food low-carbohydrate diets. I’m a formerly fat person so I have that experience as well.
Facts, they are present in this video
I reviewed the video and the transcript and my impressions are
Despite the cherry picked references which are endemic in these formats, the points made about using isocaloric diets in research corroborate the data I’ve seen
Agreed that studies that move people from highly processed to unprocessed, real foods tend to show improvement, plant based or plant free. This is a huge problem in nutrition research.
Anything is better than the standard American diet (SAD)
More cognitive dissonance – telling people what not to eat, forgetting that they will eat something in its place
I see a link to a video cautioning against eating too much soy, as well as an animation showing virtually all food choices removed from the standard American diet. This gets us back to a big problem – people ultimately will eat something. That’s sort of required….
I actually use the photo above in a montage to elucidate how much better a meal like this is than the meals that health professionals and climate change experts serve themselves at their own meetings. Take a look:
Yes, CRAP. Note: these “replacements” are all plant-based.
Plant-based does not have to be unhealthy (and neither does animal-sourced). These versions of it are, and sadly, they are the ones I see the most of in these settings.
2019.06.27 Low Carb and Low Carbon, Washington DC USA 1780005 (View on Flickr.com)
Your Readers – Now they’re confused
The tone and tenor of this one isn’t as negative as the other ones
The comments also belie the false dichotomy of this series, that a very-low-carbohydrate diet is the opposite of plant-based one (it’s not).
The question that keeps getting asked is not responded to – “Can a plant based diet be low carbohydrate?” – it’s asked again, and again, and again (answer is yes)
Your readers are now confused
I thought Dr Greger said in a previous video that keto diets are bad, the example he used was about the man who went on one and then he had a heart attack.
Why is there contradictory information I don’t know what’s healthy or not.
Thank you for the platform
I’m still working on food photography – I could not have predicted that a/the platform for sharing my work would be NutritionFacts.org. If they help humanize the drive to achieve and maintain metabolic health for all people, I’m in support, and I celebrate all people who are finding their way to a long health span and life span.
Enjoy the photo. There are more coming, and I still ask the question, “We’re in the era of diabetes reversal, why don’t more doctors know?”
Might the appetite-suppressing effects of ketosis improve dietary compliance?
This week’s photographs were taken at Glenstone, a whimsical and biophilic place not far from Washington, DC, as well as a photographic cornucopia. There are also very powerful sights and sounds that photography cannot convey. We’re grateful for the gift that this museum is to our community.
Enjoy.
Glenstone is a place that seamlessly integrates art, architecture, and landscape into a serene and contemplative environment.
Thank you for using my photograph as the thumbnail/opener for this video, Nutrition Facts (TW:Nutrition_Facts).
About this photograph, I have to say it was an incredible meal because it
included real rood
was cooked by people who have achieved metabolic health
was shared with board certified family medicine specialist physicians ( I am one too 🙂 ) and citizen scientists of a caliber I hope every doctor and nurse get to interact with in their lifetime.
Ted Eytan, MD, MS, MPH, Ken Berry, MD, Jeffrey Gerber, MD – 2018.07.21 Ketofest, New London, CT, USA 04928 (View on Flickr.com)
Dave’s ever present scale also made it into the shot, because, he’s an engineer and interested in facts.
As far as I can tell, we’re all maintaining our weight on our real-food low-carbohydrate diets. I’m a formerly fat person so I have that experience as well.
Do people want physicians to engage in a diet war, or a health peace?
I reviewed the transcript of the video and my reactions are
Where did the facts go? I didn’t see/hear them 🙂
A pilot study of 12 participants, where reported vastus lateralis changes were not even statistically significant? c’mon… 😛 Try this study instead. Again, facts…
I’m concerned about the tone and tenor & accompanying hashtags which do not appear empathetic or pro-human, which seems to permeate these pieces, and is reflected in the pushback from the comments attached to the video.
The comments also belie the false dichotomy of this series, that a very-low-carbohydrate diet is the opposite of plant-based one (it’s not).
If I perceive the use of one of my photos is frankly anti-human or denigrating, I’ll terminate the license to use the photo (I have done this several times for other outlets). I would say this is on the line because it illustrates non-factual information – if others have opinions on this, I’d be happy to hear them.
Yes! Dr. Greger BURNING the opposition. 🙂
The opposition?” Sounds like tribalism.
All of that said, I do appreciate videos like the below, which address a significant problem of conflict of interest in the nutrition space:
As of late I have been working on food photography, so good to see how one of my images would be selected. This was an outdoor shot using a rented fancy camera, I’m pleased how it turned out, visually and physically.
Enjoy the photo. There are more coming, and I still ask the question, “We’re in the era of diabetes reversal, why don’t more doctors know?”
I don’t know, @Nutrition_Facts_org, I’m a board-certified family medicine specialist, and I seem to be managing my weight using actual facts…. More importantly, thanks for publishing another one of my photos! Again, though, your facts are missing, here are some: The photo was taken while sharing an awesome meal with fact-based physicians and citizen scientists @kendberry.MD @JeffryGerberMD@DaveFeldmanKeto@righthandsiobhan I agree with the pushback from your readers – #PlantBased and #LowCarbohydrate are not in opposition. It’s a health peace, not a diet war, aka what the people we serve expect from their doctors. Larger images and more info about the photo and the meal: https://instagram.tedeytan.com We’re in the era of #DiabetesReversal, why don’t more doctors know? Next time, Michael Greger should enjoy this with us… #DataOverDogma #LCHF #RealFood #FoodNotPharma #Science #FamilyMedicine #DiabetesPrevention #fitness #gayfitness #LowCarb #LowCarbon #ketogenicdiet
Low Carb and Low Carbon – Ted Eytan MD 1001-766 – “The pharmaceutical sector is far from being a green sector. In fact, the sector’s emission intensity in 2015was 48.55 Mt-CO2e/$M, which is about 55% higher than that of the Automotive sector of 31.4 Mt-CO2e/$M for that same year (Jackson and Belkhir, 2018). In absolute value, we estimated the aggregate global emissions of the Pharma sector to amount to about 52 MMt-CO2e in 2015 compared to about 46.4 MMt-CO2e emitted by the global automotive sector in that same year (Statista, 2018a) (where ”MMt” indicates Million of Metric tons).”
I was highly interested in reading this paper because I have informally worked to understand the greenhouse gas (GHG) emissions of the pharmaceutical industry through their own web sites, and usually leave confused and uninformed. Apparently, it’s not just me.
This analysis includes the use of datasets that are not publicly available for the major pharmaceutical companies that report their emissions. The authors also compared absolute number of emissions and relative emission intensity, to take growth and revenue into account.
Unexpectedly, we found that the Pharma industry, on average, is a higher intensity emitter than the automotive industry … Also, we have found a much greater variability among the Pharma industry than the automotive industry.Belkhir L, Elmeligi A. Carbon footprint of the global pharmaceutical industry and relative impact of its major players. J Clean Prod [Internet]. 2019;214:185–94.
The authors further cite a lack of transparency that I also found in my informal review:
…overall the environmental performance of the pharmaceutical sector in general, and their GHG emissions in particular, are much worse than generally portrayed by the industry’s greenwashing tactics and their sustainability reports.Belkhir L, Elmeligi A. Carbon footprint of the global pharmaceutical industry and relative impact of its major players. J Clean Prod [Internet]. 2019;214:185–94.
How this is related to diet and a Sustainable Diet
The average US person who has diabetes requires almost $5000 USD/year of diabetes medications. This translates into 2.01 metric tons CO2/year emissions, exceeding the amount of emissions they might save by going vegan in one year, for example.
If a person was able to reverse their (Type II) diabetes or otherwise reduce their medication use, their carbon footprint would go down, significantly so. The American Diabetes Association has amended their lifestyle recommendations from January, 2019 to suggest exactly that:
For select adults with type 2 diabetes not meeting glycemic targets or where reducing glucose-lowering medications is a priority, reducing overall carbohydrate intake with low- or very low carbohydrate eating plans is a viable approach.American Diabetes Association. 5. Lifestyle Management: Standards of Medical Care in Diabetes—2019. Diabetes Care [Internet]. 2019 Jan 1 [cited 2019 Sep 5];42(Supplement 1):S46–60.
Unfortunately, a significant amount of cognitive dissonance exists inside and outside of the medical profession, resulting in policies like this:
2019.06.27 Low Carb and Low Carbon, Washington DC USA 1780005 (View on Flickr.com)
The interesting case of Bayer
Bayer is a conglomerate of the most interesting kind in this space. It manufactures:
Producing products derived from bioengineering, as well as those created to manage their potential harms to human health (View on Flickr.com)
Pharmaceuticals
Medical Devices
Agricultural commodities (including soybeans of the GMO variety, perhaps ones of the kind used in today’s ultra-processed artificial-food burgers)
I might call this the trifecta of chronic disease creation and mitigation all at the same time.
Bayer also does not break out its GHG emissions by division, which gives it an extremely high emissions intensity compared to the other companies who report, about 4.2 times greater than the pharmaceutical sector.
To make matters worse, Bayer reports and tracks its emission intensity in terms of tons ofCO2e per ton ofmanufactured sales volume (Bayer, 2015, 2018), regardless of whether the man- ufactured goods are pharmaceutical products, medical devices or agricultural products. In other words, a ton of fertilizer and a ton of aspirin, are equally accounted for with respect to the level of emissions they generate.Belkhir L, Elmeligi A. Carbon footprint of the global pharmaceutical industry and relative impact of its major players. J Clean Prod [Internet]. 2019;214:185–94.
Climate change is a threat to human health. Physicians have an important role to play in understanding and supporting pathways to healthy people and healthy planet, not one or the other.
This is one of the best books I’ve read in a long time. Why?
It covers a topic I know very little about, how our food is produced. I’d argue the overwhelming majority of my physician colleagues don’t know much about this either. Some pretend to know about it, which is more harmful than not knowing.
Climate change is a threat to human and planetary health; if there’s a way to mitigate it, I want to know about it. Diabetes is also a threat to human and planetary health, same desire.
I have found over my career that the dogma that’s been handed down to us falls down when we investigate the science ourselves. Name the issue, so many…
“Defending Beef,” Not “Defensive About Beef”
Author Nicolette Hahn Niman (@DefendingBeef) writes from a unique perspective. She’s a trained biologist, an environmental attorney, a vegetarian, and a cattle rancher. The book is well referenced and includes many of the studies I’ve read and known as important in the space.
Maybe the only thing that may be out of date on the health connection since the book was published in 2015 is the topic of heterocylic amines, cited as a cause of cancer. Here again, the science is far from clear/valid/high quality. If anyone can find a good human RCT on this topic, send my way, I have been unable to…
The basics about how cows are raised for beef, dairy, and by extension the differences and similarities to other livestock agriculture are barely understandable to me; the writing made these things much more understandable.
The responsibility to be a good meat consumer, rather than a non-consumer
2018.05 Low Carb and Low Carbon – Ted Eytan MD 1002-732 (View on Flickr.com)
For a person with insatiable curiosity, the book dives instantly into the concerns about beef production and consumption, including environment, health, and morality.
The book also includes high quality critiques of the beef production industry and the idea that seems to permeate all of food production, a race to the bottom of cost/quality, because of perceived consumer demand.
I wonder myself whether the dogma around beef in our society unfortunately feeds this problem, by forcing people who eat meat into the culinary closet. For those who do follow the dogma and replace beef in their diet, the evidence so far has been that they do so with highly-processed, less stable foods, with this well characterized result.
What Happened? – 2018.05.30 Washington, DC Low Carbohydrate Meetup, Washington, DC USA 01-458 (View on Flickr.com)
Sadly, we know how well this turned out in many other medical profession quests for what became moral self-license – 100% failure, with the devastation of many humans and the people who love them. See the photographs at the bottom of this post (Just Read: On Eating Meat, by Matthew Evans) for visual examples of the history of a medical profession unable to be introspective or curious about the world around it.
The Sustainable Diet, Good Definition, Bad Interpretation?
Based on this and much other reading, I have questions about what’s called the “Sustainble Diet.” The official definition makes sense, the interpretation, assumptions and studies (mostly modeling, epidemiological) I’ve seen do not. It would be great to reinterpret and do scholarly work on sustainable diets that are sustainable, for people and the planet.
The cognitive dissonance I see in every day life is difficult to observe:
2019.06.27 Low Carb and Low Carbon, Washington DC USA 1780005 (View on Flickr.com)2018.05 Low Carb and Low Carbon – Ted Eytan MD 1001 755 (View on Flickr.com)
At the same time, the mainstream (some would say “20th Century”) media (@ConsumerReports) is now reporting a greater understanding:
“I’d rather see a low-density grazing system with grass-fed beef than to have that land converted into soybeans.” – (mainstream media 👏)
Because my generation of physicians was so let down by the generation who trained us, we have never let our guard down or our curiosity wane. I feel better able to engage on the the topic of food now thanks to the number of experts entering the field with multidisciplinary backrounds.
I can’t dialogue about agriculture without also thanking Peter Ballerstedt, PhD (@GrassBased). Peter’s a trained forage agronomist who has attended many of our scientific meetings and tirelessly attended to our education in this space. It is said that adult learning requires repetition. He’s been pleasinigly repetitive. I am now able to process much more of his teaching as a result.
We went to medical school with the determination to people take control of their health and life destiny in ways that were denied by society and sometimes the profession itself.
How cool is it in this century that whole classes of para-health professionals, from architects to forage agronomists are attending to our skill-building so we can be there for the people we serve?
Very 🙂 .
My disclaimers and disclosures
…. are on this page on this blog (I have none). I am working to update the page to reflect my current nutritional environment, a real food, low carbohydrate, healthy fat diet. Not Plant-Based or Plant-Free, Disease-Free.
Thank you for using my photograph as the thumbnail/opener for this video, Nutrition Facts (TW:Nutrition_Facts).
This is a photograph of a meal that I ate, served at the RD86 space (IG:rd86space) in New London, Connecticut, at Ketofest 2018. The meal is actually special because of who I shared it with, Nina Teicholz (@BigFatSurprise) and Richard Feinman (@DrFeinman), as well as Carl Franklin (@CarlFranklin), one of Ketofest’s hosts.
Do people want physicians to engage in a diet war, or a health peace?
I reviewed the video and my reactions are
Where did the facts go? I didn’t see/hear them 🙂
I’m concerned about the tone and tenor & accompanying hashtags which do not appear empathetic or pro-human, inclduing things like analogies to World War II German dictators. I don’t know where that fits into a scientific discourse.
If I perceive the use of one of my photos is frankly anti-human or denigrating, I’ll terminate the license to use the photo (I have done this several times for other outlets). I would say this is on the line but doesn’t cross it – if others have opinions on this, I’d be happy to hear them.
I agree with the pushback from the commenters on the video, which is that a platform like this should be used to promote the benefits/virtues of a whole foods, plant based lifestyle. I would think that’s a more authoritative place for this outlet to exist in/come from:
… I will stay your subscriber, but you definitely do a better job promoting veggies (and fruits) than criticizing different diet lifestyles…
All of that said, I do appreciate videos like this, which address a significant problem of conflict of interest in the nutrition space:
As of late I have been working on food photography, so good to see how one of my images would be selected. This was an outdoor shot using a rented fancy camera, I’m pleased how it turned out, visually and physically.
Enjoy the photo. There are more coming, and I still ask the question, “We’re in the era of diabetes reversal, why don’t more doctors know?”
The clinical use of ketogenic diets for epilepsy and cancer: what does the science say?
2018.05 Low Carb and Low Carbon – Ted Eytan MD 2-1002 756 – Farmed salmon cooked using sous-vide technique (View on Flickr.com) The numbers above and below are continuous glucose monitor measurements while eating a (mostly) meat diet for a few weeks. As the images show (and people seem to forget…), meat includes fish.
As predicted, the numbers are normal, and very stable, given meat’s glycemic index = 0. I would say they are more stable than previous measurement periods. In a person without prediabetes or diabetes, the difference isn’t materially signifcant though.
An average blood glucose of 77 mg/dl calculates to a HbA1c of 4.3 %. Laboratory measured HbA1c’s can be highly variable, based on red blood cell characteristics…
I have also found from my experience that every sensor is slightly different. See below for an example of sensor failure.
2018.05 Low Carb and Low Carbon – Ted Eytan MD-1001 757 – Grass-fed, grass-finished, pasture-raised beef pre-cooking. (View on Flickr.com)
What am I getting out of wearing a CGM? Answer: A lot
I have been getting this question (or comment) from people who know or don’t know that I’m a physician. It’s a reasonable one given that most (all) of the readings are within normal levels.
Understanding glucose metabolism for the first time
I’ve discovered from this experience that I never learned how the human body so elegantly metabolizes glucose. I’m not talking about biochemistry and physiology – we learned these in depth. Many of my professional colleagues still don’t know or understand, except through the review of lists of manually obtained glucose readings, some with context, some without.
It’s incredible what the human body can do & to see it in action for such an important metabolite. The converse is also true, it’s important to understand the situation where the body cannot manage this metabolite and how it may struggle for equilibrium.
This type of data is orders of magnitude more important for a population, than say, a 1 lead EKG as certain wearable devices are acquiring 🙂 .
Understanding the life of a person with diabetes
I have had people approach me asking, “Type 1 or Type 2” when they see the sensor. I answer “neither,” and then a great conversation ensues.
In the LGBTQ space, I say people who don’t identify this way will never ever know what it’s like.
What I hear in ways I haven’t before, and can corroborate from my own experience, is about the way people with chronic illnesses are treated. There’s also a differential in the way type 1 and type 2 diabetes are recognized and respected (or not) in our medical system. We can always do better.
Sensor failure
An experience that stands out in my mind is the phone call I made to the manufacturer when a sensor began to malfunction. The way in which I was interrogated, clearly off of a script, was something bordering on inhuman. Not the fault of the person on the other end of the phone, just a marker of the way our society approaches people with health challenges. Interestingly, once I passed through the gate as it were, replacement was made quickly, efficiently, satisfactorially. What it took to get there I will never forget….
2018.05 Low Carb and Low Carbon – Ted Eytan MD-1001-613 – Sensor failure, it happens…. (View on Flickr.com)
As I have said in other contexts with people working to control their health and life destiny, I wish this experience on every nurse and doctor in their career. It will help them be better for the people we/they serve.
2018.05 Low Carb and Low Carbon – Ted Eytan MD-1001-762 (View on Flickr.com)
We’re now in the era of diabetes reversal, why don’t more doctors know?
This week’s photos were taken in Washington, DC (of course), with curiosity about what different food products look like in reality. See if you can guess which is real or not. The answer is below, along with more info about ingredients, NOVA classification, and the Bioengineered Food Disclosure Standard.
2018.05 Low Carb and Low Carbon – Ted Eytan MD 2-1002-763 (View on Flickr.com)
The real hamburger is NOVA Group 1, the artifical one is NOVA Group 4
2018.05 Low Carb and Low Carbon – Ted Eytan MD-1001-765 (View on Flickr.com)
Here are the definitions of both:
NOVA Food Classification Group 1: Unprocessed or minimally processed foods: “Minimally processed foods are natural foods altered by processes such as removal of inedible or unwanted parts, drying, crushing, grinding, fractioning, filtering, roasting, boiling, pasteurisation, refrigeration, freezing, placing in containers, vacuum packaging, or non-alcoholic fermentation. None of these processes adds substances such as salt, sugar, oils or fats to the original food.”
NOVA Food Classification Group 4: Ultra-Processed Foods“industrial formulations made entirely or mostly from substances extracted from foods (oils, fats, sugar, starch, and proteins), derived from food constituents (hydrogenated fats and modified starch), or synthesized in laboratories from food substrates or other organic sources (flavor enhancers, colors, and several food additives used to make the product hyper-palatable). Manufacturing techniques include extrusion, moulding, and preprocessing by means of frying.”
(The bacon and cheese would be Group 3: Processed foods)
The Bioengineered Food Disclosure Standard from the USDA
2018.05 Low Carb and Low Carbon – Ted Eytan MD 3-1003-764 (View on Flickr.com)
U.S. Secretary of Agriculture Sonny Perdue announced the National Bioengineered Food Disclosure Standard on December 20, 2018. The National Bioengineered Food Disclosure Law, passed by Congress in July of 2016, directed USDA to establish this national mandatory standard for disclosing foods that are or may be bioengineered.
The Standard requires food manufacturers, importers, and certain retailers to ensure bioengineered foods are appropriately disclosed.
I put this question to a vote on another social network, and most people could tell the difference. Still, they both make for great food photos. Enjoy.
