Washington, DC Low-Carbohydrate Lifestyle Meetup: Food Entrepreneurship within a Desolate Industrial Food Landscape

2018.08.14 Washington Low-Carbohydrate Lifestyle Meetup, Washington, DC USA 05627
2018.08.14 Washington Low-Carbohydrate Lifestyle Meetup, Washington, DC USA 05627 (View on Flickr.com)

If you don’t like the news, go make your own / the future doesn’t create itself / the future has to start somewhere and it’s usually here.

Thank you David Birsen & Nadine Calderon, founders of Washington, DC based Revol Snax (@RevolSnax) and part of Washnington, DC’s Union Kitchen Accelerator (@UnionKitchenDC) for presenting at the Washington Low-Carbohydrate Lifestyle Meetup.

They discussed food entrepreneurship & positioning healthier options within an otherwise desolate industrial food landscape. What is fascinating to me is that entrepreneurs in this space need to think carefully about positioning because fat is still demonized in the food world, despite the fact that international experts have agreed that this era is over. (see: Photo Friday: Narrative Art and Exploding Myths in the era of Diabetes Reversal)

This comment by @ZoeHarcombe is appropriate here: Could we agree to demonize processed food, not saturated fat? | The BMJ

Thanks also @WeWork Apollo, in Washington, DC, for providing the space.

More photos from the discussion below. I will never tire of seeing/listening to the voices of human beings taking control of their health and life destinies. It’s what we came to health care to do.

Reminder of my statement of independence and (lack of) conflict of interest:

2018.05.29 Low Carbohydrate Meetup Washington, DC Presentation  453
2018.05.29 Low Carbohydrate Meetup Washington, DC Presentation 453 (View on Flickr.com)

Thanks for Quoting me, in Transgender advocates adopt lobster emoji – Portland Press Herald

Thanks for quoting me in this piece mentioned below, Portland Press Herald (@PressHerald).

I agree with the sentiments of the artists (Charlie_Craggs) starting this movement – Emoji is (has become) more than just a character set. Inclusion and exclusions of significant parts of society can be reflective of bias:

“Emojis are a way for the world to connect and trans people shouldn’t be left out of the conversation,” the group said. “Unicode granted the lobster emoji proposal, which argued that people suffered ‘frustration and confusion’ at having to use a shrimp or crab emoji instead of a lobster. Imagine if that was your gender. Surely we deserve the same rights you have afforded crustaceans?”

And, it’s great that the orginators of the lobster emoji campaign also support inclusion:

“Lobster is for everyone,” the Cape Elizabeth native said by email. “So until Unicode does right by the trans community, we fully support using the lobster emoji to advocate for their right to be represented.”

My quotes are accurate; as a physician, humanist, person working to help the 🌎 learn to ❤️ better, they are an extension of what I say, which is, equality equals health, visibility equals life.

Comments welcome and here’s a video from the campaign. Feel free to review the proposal itself to Unicode, from which we continue to be met with silence.

Transgender Pride Flag Emoji Submission for inclusion in the Unicode Standard for 2019 (Update 12: Pride Month, Technical Update, Now it’s a Social Movement)

In the meantime, they are pushing an online petition for their own pink-and-blue emoji.

Source: Transgender advocates adopt lobster emoji – CentralMaine.com

Thanks for Publishing my Photo, in The Morning Metropolitan | The Georgetown Metropolitan

2018.08.09 DC People and Places, Washington, DC USA 05535
2018.08.09 DC People and Places, Washington, DC USA 05535 (View on Flickr.com)

Thanks for publishing my photo, @GeorgetownMet.

Isn’t Washington, DC beautiful?

Photo by Ted Eytan. Good morning Georgetown, here’s the latest: More on those snakes that shut down the library. Arrest made after string of sexual assaults in and near Georgetown. News is sl…

Source: The Morning Metropolitan | The Georgetown Metropolitan

Thanks for Publishing my Photo, in Morning Roundup: DCist

2018.08.09 DC People and Places, Washington, DC USA 05515
2018.08.09 DC People and Places, Washington, DC USA 05515 (View on Flickr.com)

Thanks for publishing my photograph, @DCist.

It was taken near dusk in Georgetown, Washington, DC USA (of course). Rosslyn, Virginia is in the background.

Enjoy.

Plus, problems at the D.C. VA hospital, new museums in the works, and other morning news.

Source: Morning Roundup: Scammers Target Men In Chevy Chase With Extortion Letters: DCist

Photo Friday: The Inextricable Linkage between Health and Sustainability, Washington, DC USA

2018.08.06 Metabolic Health and WeWork White House, Washington, DC USA 05488
2018.08.06 Metabolic Health and WeWork White House, Washington, DC USA 05488 (View on Flickr.com)

Health and sustainability are inextricably linked. Sick humans on a healthy planet are not more sustainable than healthy humans on a sick planet.

I applaud WeWork’s (@WeWork) commitment to the environment. Climate Change is a threat to human health.

At the same time that meat is not being catered for corporate events, there are copious quantities of insulinogenic and diabetogenic foods served and promoted within the premises. From a science perspective, the carbon emissions from agriculture in the United States are 10% of the total.

The carbon emissions from health care in the United States are 10% of the total.

A population struggling to prevent insulin resistance (up by 41% in Washington, DC, 76% Nationally, 1.67 million people in MD/VA/DC have pre-diabetes or undiagnosed diabetes, most don’t know it) will create a most unsustainable environment for all, through increased use of pharmaceuticals and associated health care. See this image to see what happens to humans when they ingest these foods

2018.08.06 Glucotypes reveal new patterns of glucose dysregulation 509

It’s estimated that the use of $200/month of pharmaceuticals equals the GHG offset from going completely vegan in 1 year. Same for taking one (1) transcontinental flight.

A sustainable food policy that incorporates health and the environment together helps us think about healthy humans and a healthy planet.

Just Read: Increased Cardiovascular Risk in Hypertriglyceridemic Patients With Statin-Controlled LDL Cholesterol – Impact of Nutrition? (not discussed)

This is a study done using data from Kaiser Permanente, performed by the Kaiser Permanente Center for Health Research (@KPCHR), looking at the relationship between triglyceride levels and cardiovascular disease in a group of patients who had their LDL’s controlled (values of 40 to 100 mg/dl). H/T @MacroFour for the link.

I believe the paper was brought to my attention because of the ongoing discussion about the value of LDL-C as the sole determinant of CVD risk. A previous study performed at Kaiser Permanente also suggests that we may need to rethink this idea: Just Read: Challenging the role of LDL vs Insulin Resistance in predicting heart disease, via Kaiser Permanente data.

The researchers found a significant association between higher triglyceride levels and CVD events, even with LDL’s controlled.

I had some additional questions/comments based on the study:

Impressive insulin resistance patterns in the study group

This was touched on a little

Patients in the high TG group (n = 2702) were significantly different from patients in the normal TG group
(n = 14,481); they were younger and more likely to be white or Hispanic, to smoke, to have lower HDL-C levels, and to have a higher prevalence of diabetes and
CKD (Table 1).

Indeed, the average HDL in the high TG group was 40 mg/dl, average TG 243 mg/dl. In single human, that would be a ratio of 6.1, very (very) indicative of insulin resistance.

and

It must be noted that 50% of the high TG group had a diagnosis of diabetes at baseline (vs. 38% in the nor-mal TG group), a variable we controlled for in our multivariate analysis.

No mention of nutrition

The authors mention currently underway drug trials to manipulate triglyceride levels, but do not mention how triglyceride levels are modulated by diet. This makes parts of the analysis very difficult to understand for me, because of established patterns of TG/HDL that occur with different dietary patterns.

Indeed, in studies where people move away from the Standard American Diet (SAD), both markers improve together (example: Just Read: An Online Intervention Comparing a Very Low-Carbohydrate Ketogenic Diet and Lifestyle Recommendations Versus a Plate Method Diet in Overweight Individuals With Type 2 Diabetes: Watch the Triglycerides).

In another study, the DIETFITS study, the arm of the study that went higher carbohydrate experienced a worsening of this pattern compared to the arm that went lower carbohydrate (see: Just Read: DIETFITS and Effect of Low-Fat vs Low-Carbohydrate Diet, real food is better, is the low fat diet worse for metabolic health?).

The paper contributes to the idea that lipids are much more relevant as a pattern than as a single matter. The question I have is whether each marker should be treated reductionistically as something to be reduced by single interventions.

Comments welcome as usual.

Just Read: Federal Commission for Nutrition. Vegan diets: review of nutritional benefits and risks. Expert report of the FCN

Federal Commission for Nutrition. Vegan diets: review of nutritional benefits and risks. Expert report of the FCN [Internet]. Bern: Federal Food Safety and Veterinary Office 2018. Available from: https://www.eek.admin.ch/eek/de/home/pub/ernaehrungsbezogene-und-gesundheitliche-vor–und-nachteile-einer.html (scroll down for English version)

In the #FMRevolution, there’s no limit to ideas of interest when it comes to health…

First (#Food4Thought18), now this. The Swiss are leading in (#DataOverDogma).

This work offers a very useful perspective in an unbiased way (no conflicts except for Diego Santini representing the Vegan Society Switzerland)

  • respecting the diversity of humans who choose vegan (and vegetarian) diets – Overwhelming majority choose for ethical reasons (only 18%-35% for health) with impacts on food choices (non-health choosers may not make healthier food choices)
  • Need to take nutrient deficiencies into account and supplement, not all vegans do this – “The data show however that this ideal well-planned diet is not always followed”
  • Studies have tons of limitations about health impacts pro/con – lots of data in here ranging from all-cause mortality to mental illness. All are worthy of dialogue.
  • Vegan diets not recommended for pregnant women, toddlers, children, or adolescents
  • Impact on environment not in scope – so this is about people, not planet (again, only one side of the equation, health is more inclusive in my opinion)

Citation

Federal Commission for Nutrition. Vegan diets: review of nutritional benefits and risks. Expert report of the FCN [Internet]. Bern: Federal Food Safety and Veterinary Office 2018. Available from: https://www.eek.admin.ch/eek/de/home/pub/ernaehrungsbezogene-und-gesundheitliche-vor–und-nachteile-einer.html (scroll down for English version)

Thanks for Publishing my Photo (and allow me to summarize), in Protecting minority rights can undermine the legitimacy of the Supreme Court in the eyes of many Americans | LSE USCentre

SCOTUS APRIL 2015 LGBTQ 54663
SCOTUS APRIL 2015 LGBTQ 54663 (View on Flickr.com)

Thank you (again) for publishing my photograph, @LSEUSAblog, in this piece written by Michael Zills.

I understand the premise, however, I can be much more efficient in expressing it, to save time:

  • Change = Loss
  • Love Always Wins
  • This Century is the Best Century

Might as well add these

  • Equality Equals Health
  • Visibility Equals Life

My generation of physicians came to health care (and society) to change everything. So far, I’d say we’re on track 🙂 .

Enjoy the photograph

Since 2010, the Supreme Court has handed down a number of landmark decisions which have dramatically increased gay rights in the US. But these decisions have often led to a backlash. Using national…

Source: Protecting minority rights can undermine the legitimacy of the Supreme Court in the eyes of many Americans | USAPP

Just Read: New Insights into Glucose Dysregulation from Continuous Glucose Monitoring & Foods Most Recommended for Reversing Prediabetes Seem to Have Greatest Potential to Cause Prediabetes

2018.08.06 Glucotypes reveal new patterns of glucose dysregulation 509
2018.08.06 Glucotypes reveal new patterns of glucose dysregulation 509 (View on Flickr.com)

This was bound to happen, and h/t Zoe Harcombe (@ZoeHarcombe) to alerting us to this new study looking at the measurements coming from continuous glucose monitors in a 30-57 subjects all various states of metabolic health.

New technology shows early signs of metabolic unhealth

In the slide above, the challenges to glucose regulation can be seen for three different meals. The one with the greatest problems is the cereal with milk and raisins. This meal is incidentally the lowest calories, lowest fat of the three meals.

There are some foods that result in elevated glucose in the majority of adults. A standardized meal of cornflakes and milk caused glucose elevation in the prediabetic range (>140 mg/dl) in 80% of individuals in our study. It is plausible that these commonly eaten foods might be adverse for the health of the majority of adults in the world population.Hall H, Perelman D, Breschi A, Limcaoco P, Kellogg R, McLaughlin T, et al. Glucotypes reveal new patterns of glucose dysregulation. 2018; Available from: doi.org/10.1371/journal.pbio.2005143 (used under Creative Commons license)

and

2018.08.06 Glucotypes reveal new patterns of glucose dysregulation 510
2018.08.06 Glucotypes reveal new patterns of glucose dysregulation 510 (View on Flickr.com)

…severe glucose variability was present in 25% of normoglycemic individuals, and within this subgroup, glucose reached prediabetic or diabetic glucose levels 15% and 2% of the time, respectively.Hall H, Perelman D, Breschi A, Limcaoco P, Kellogg R, McLaughlin T, et al. Glucotypes reveal new patterns of glucose dysregulation. 2018; Available from: doi.org/10.1371/journal.pbio.2005143 (used under Creative Commons license)

As a reminder, In 1990, 2.52% of the U.S. population had diabetes. It’s now 9.4%, 12% of adults. It’s estimated that 25% of adults will have diabetes in the US by 2030, 33% by 2050. Prediabetes converts to type 2 diabetes with an annual rate of approximately 10%. 55% of Californians now have some level of insulin resistance.

Curious statement about the American Diabetes Association – favoring a low carb approach?

The authors made this statement which most people in this space would find curious (i.e. incorrect)

Zeevi and colleagues found that the postmeal glucose response to identical foods varies across individuals [11]. This is an important finding, given that the American Diabetes Association (ADA) dietary recommendations are based mainly on reduction of carbohydrate content…Hall H, Perelman D, Breschi A, Limcaoco P, Kellogg R, McLaughlin T, et al. Glucotypes reveal new patterns of glucose dysregulation. 2018; Available from: doi.org/10.1371/journal.pbio.2005143 (used under Creative Commons license)

As Mark Cucuzzella, MD, a family medicine specialist at West Virginia University School of Medicine points out, there’s no mention of lowering carbohydrates whatsoever on this website:

DoIHavePrediabetes.org | Reverse Prediabetes

The same goes for the current (2018) ADA Standards of Care.

Here’s what is mentioned on the website linked above:

Believe it or not, salads CAN be delicious. Look up interesting ways to prepare them and other vegetables, and aim to eat at least one at dinner every night.
Low-fat doesn’t have to be low on flavor. So try to cook in these ways: roast, broil, grill, steam or bake — instead of deep-frying or pan-frying.
Reading food labels is so important. The more you know about what goes into your food, the better decisions you’ll be able to make. Also, try and cut down on foods with saturated fat or trans-fat, and hydrogenated fat or partially hydrogenated fat. Check labels to help you make healthy choices.
Choose foods with less sodium than your usual choices.

There’s an infographic present on the site, however, none of the steps mentioned for reversing prediabetes mentions lowering carbohydrates. Actually, the steps recommend eating the type of meal above that spike most people’s serum glucose.

Here’s Mark’s presentation, it’s worth a listen in terms of doing things to improve the health of people and communities we serve. H/T Jeffry Gerber, MD (@JeffreyGerberMD)

Reference

Hall H, Perelman D, Breschi A, Limcaoco P, Kellogg R, McLaughlin T, et al. Glucotypes reveal new patterns of glucose dysregulation. 2018; Available from: doi.org/10.1371/journal.pbio.2005143 (used under Creative Commons license)

Photo Friday: Narrative Art and Exploding Myths in the era of Diabetes Reversal

2018.08.01 Grass-Fed Beef, Sous-Vide Technique, Washington, DC USA 05385
2018.08.01 Grass-Fed Beef, Sous-Vide Technique, Washington, DC USA 05385 (View on Flickr.com)

I’ve discovered that what I do has a name – “Narrative Art” (thank you George Lucas)

Every photo tells a story, I’ve been asked to tell this one (just this once…)

There doesn’t seem to be an enormous mea culpa from the scientific community that we got it wrongFiona Godlee, Editor in Chief, The BMJ, June 15, 2018, #Food4Thought18

  1. This photograph is about exploding myths
  2. Yes it is animal sourced, grass-fed 🥩 – real food, glycemic index = 0
  3. Cooked using the Sous-Vide technique
  4. I’m here not to be plant-based or plant-free, to be chronic-illness free (or maybe “life-full”)
  5. This is not about telling people what to eat, it’s the opposite. There are many options to prevent or reverse diabetes, high blood pressure, CVD with food. What we’re often presented with is the absence of them, which is not what I consider meeting people where they are (see: Why Doctors should meet patients (and each other) where they are: My intersection of #LGBTQ , #LCHF, and #LetPatientsHelp)
  6. Steak has more unsaturated fat than saturated fat (70% unsaturated per 100g), comparable to salmon (76% unsaturated per 100g) + most of the saturated fat in the American diet comes from processed food.
  7. A linkage between saturated fat and CVD does not exist. The ability to reverse diabetes does exist. Watch below as international experts both confirm this and lament our inability to admit it (quote above)
  8. I’m practicing food photography

Thank you to the people taking control of their health and life destinies for asking the questions that get us these answers, in this case Richard Morris (@2KetoDudes)

The biggest conflict of interest is your own belief systemSalim Yusuf, Distinguished University Professor of Medicine, McMaster University

Hope that helps, future photos will need to tell the story by themselves 🙂