– If ‘all disease is inflammatory’ is diet the first line of defense?
by Howard Wolinsky, Contributing Writer, MedPage Today
October 11, 2017
I’ve paid attention to diet and weight on and off as an adult. Mostly off.
Through my 30s, I was thin as a dime. But eventually, middle-age caught up with me as I put on weight and cholesterol became an issue.
First the Heart
In 2004, when I was 57, I had a rude awakening: I experienced a mild strange twitch in my chest and a radiating pain on my right arm — atypical MI symptoms. But the cardiologist said I had experienced the legendary “widow maker” Angiography revealed a 97% blockage of the left anterior descending artery. Two stents were implanted.
But no one could tell me exactly why this had happened. The cardiologist said I was a rare patient whose HDL and LDL were the same: 70.
Although there was no definite “cause” cited one likely explanation given to me was that it was an inflammatory reaction in which plaque broke off and blocked the artery.
The STEMI did virtually no permanent damage and thanks to 40 years of exercise that created collateral circulation, I beat the odds of recurrent MI. Life resumed.
I consulted back then with a dietitian who recommended a heart-healthy diet, pretty much what I was doing already. Salmon twice a week; lots and lots of vegetables and fruits; oatmeal every morning and turkey sandwich for lunch, day after day. Virtually no red meat. Instead, I had chicken, more turkey, some pasta and vegetarian entrees for dinner.
I was Mr. Low Fat. They say you should get a chronic disease and take good care of it and you’ll live a long life. I was on that path.
I stuck with the diet religiously for about 5 years and kept up my exercise, but I found I packed on weight more easily in my 60s. The strains of life and work plus the boredom and monotony of the diet got to me.
Then the Prostate
I got body-slammed at age 63 in 2010 with the diagnosis of prostate cancer.
I lucked out again. I was diagnosed with Gleason 6. Only a tiny sliver of low-risk cancer has ever been seen in a single core — once in five biopsies.
I have been on active surveillance for 7 years.
I asked the urologists I’ve seen about diet and prostate cancer. They basically said not much was known. They offered little advice other than stay away from red meat, eat tomatoes, keep the weight down.
I participated in a dietary study through the University of Chicago. But I landed in the control group. They only handed me a pamphlet and said I needed to lose weight.
I was disappointed. So I joined Weight Watchers and dropped about 40 pounds.
Diet boredom eventually set in again, even though I knew better.
In June 2017, I got hit again.
Now the Pancreas
It was a big one — and it happened fast: I went from being diagnosed with pre-diabetes to type-2 diabetes in a matter of months.
Ugh.
These chronic diseases seemed to be sending me a message.
My fasting blood glucose was 141 milligrams/deciliter, just over the line from pre-diabetes. But my A1C, a 2-to-3-month reading, the gold standard, was 7.8%, well into T2D-land.
My family doctor told me food now was going to my medicine — plus 2,000 mg of metformin.
Off to the diabetes clinic for me.
There, a nurse practitioner gave me the gospel according to the American Diabetes Association. I had to pay attention to carbs. I was no longer Mr. Low Fat. I should eat loads of vegetables. I like broccoli and cauliflower and Brussels sprouts. I could enjoy blueberries, strawberries and raspberries, but needed to be careful about other fruit that could send my blood sugar soaring.
The NP said ADA allowed me 130-145 grams of carbs per day.
I am a compliant patient. It turns out I misunderstood what the NP told me, or she wasn’t clear enough.
I found it difficult to reach that level of carbs daily. I found myself adding bread to reach those levels. It was a struggle.
When I finally saw Gwen Woodruff, MBA, RD, CDE, dietitian/diabetes educator at Advocate South Suburban Hospital in Hazel Crest, Illinois, a month later, she informed me I didn’t have to consume so many carbs. I complained I had to force myself to eat three meals a day. She didn’t laugh. She said I should eat when I was hungry and not feel compelled to eat three meals per day.
Woodruff said I needed to have produce and protein at every meal.
“Healthy eating and blood sugar control are not just about how many carbs you consume,” she said. “It’s what ratio of carbohydrates, proteins and fats you have at your meal. Eat protein at every meal and snack to help stabilize your blood sugars.”
“Dietary Crack”
She described carbs in bread, cereal, rice, pastas and crackers as “dietary crack” and should be minimized.
I bid farewell to many of my favorites: crusty pizza, spaghetti, oatmeal. It was easier for me to go cold turkey initially than to do more of a balancing act.
She suggested I might consider a very low-carb diet. We could discuss that at a later date. Meanwhile, I lost 5 pounds since my first visit, even though I had made rookie mistakes.
I was traveling in the Pacific Northwest for most of the next month. I could observe the diet habits of my younger brother Steve, who has controlled T2D for 15 years. I was a newbie and stricter than Steve. I didn’t force myself to eat carbs. In fact, I had maybe 20-40 grams of carbs per day versus the up to 145 grams recommended by ADA per day.
On the road, I was puzzled about what I perceived as the differences between a heart-healthy and an anti-cancer diet with low fat and high carbs versus a low-carb diet for diabetes.
By chance through a prostate cancer support group, I heard about a booklet about prostate cancer and nutrition written by Natalie Ledesma, MS, RD, CSO of the University of California, San Francisco and Smith Integrative Oncology.
She wrote: “Good nutrition may reduce the incidence of prostate cancer and help reduce the risk of prostate cancer progression. There are many studies currently being conducted that will help to further understand how diet and prostate cancer are related. Current research already shows that improved nutrition reduces risk of heart disease, diabetes, and obesity, and usually improves overall quality of life.”
Sounded promising. She recommended, based on research, plenty of fruits and vegetables and high fiber – whole grains and beans/legumes.
But the dietitians and NPs I saw had steered me away from fruits and beans and legumes. There are leg-men. I am, as it happens, as legume-man, a lentil lover.
I wrote an email to Ledesma.
Ledesma congratulated me on staying the course with prostate cancer. She noted that she is updating her booklet.
She essentially agreed with Woodruff that I first needed to control my glucose levels. “With the elevated blood sugar, I agree with lowering carbs – monitoring glucose, A1C, insulin can be key both for diabetes and prostate cancer. If you’re consuming healthy fats, you can liberalize those some as you’ll need to replace the carb calories to some degree,” she said.
She recommended that I consult with her on the phone. I pointed out I would be in San Francisco the following week. I went to see Ledesma in person.
This was about 2 months after the diabetes diagnosis and 1 month after I started eating intuitively — when hungry and not forcing carbs.
She figured I was eating at most 40 grams of carbs per day. I was down about 15 pounds in two months. She told me I likely was in ketosis, burning fat stores.
Here’s what she advised:
- Half of my plate should always be filled with tons of vegetables. And those vegetables could be kale salad. It could be a broccoli and cauliflower sauté. It could be zucchini. It could be a handful of tomatoes. It could be sugar snap peas. It could be beets. It could be some carrots. Whatever you enjoy.
- Consider the following vegetables in the starchy carb category — green peas, corn, butternut squash, acorn squash, sweet potatoes. She recommended I keep those to 25% or less of a plate. Get tons of greens on a daily basis whether that’s a green smoothie because you didn’t have the cooked greens or you’re traveling and you bring along a green powder or you’re in San Francisco so you can get green vegetable juices where it’s just pure vegetable juice but not having a fruit component in there.
- Fats ought to include avocado, olive oil, almonds or nuts or seeds. These fats would be much preferred over butter or ice cream or cheese and red meats. Limit red meat to not more than once a week, but possibly less, and go for high quality.
- In terms of the dairy, there definitely is a link of dairy and prostate. Some feel like it’s more a link with advanced prostate cancer. There isn’t enough evidence to not to have dairy at all, but be cautious with dairy consumption.
- Eat fish, such as wild salmon, sablefish/black cod, sardines and herring.
I’ve Seen the Enemy and It’s Inflammation
Now I have two dietitians in my corner, and they agree that I should follow an anti-inflammatory approach to help with type-2 diabetes as well as prostate cancer and cardiac disease. Lots of chronic diseases to take care of.
When I saw Woodruff in September, she said I mostly likely was in ketosis. I had lost 25 pounds 3 months after diagnosis.
I underwent follow-up glucose testing. In three months, my fasting glucose had dropped to 90 from 141, and my A1C fell to 5.9%, from 7.8%. I was close to non-diabetic levels. It was a gift for my 70th birthday.
The bottom line, from heart disease to prostate cancer and diabetes, is to fight inflammation by adjusting your diet,
As a next step, Ledesma suggested I undergo a micronutrient testing to determine if any supplements could help me to even better control my blood sugar and potentially improve my health in other ways.
I am psyched and aiming to reach normal blood glucose levels. I want to kick diabetes’ ass.
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