Wednesday, July 27, 2022

To Diet or Not to Diet...That is the Question. Part 1: Insulin Resistance, Carbohydrates, and what not to eat

A prologue for this is here.

For the first time in my life, I decided to give a diet a shot. My recurring body pains, and low energies needed a solution. Generic advice on better sleep or better food was simply not enough! However, I was not planning on approaching the OPOS initiate program as a diet, but to see which parts of the diet plan I could adopt as a lifestyle change, meaning which parts of the diet plan are sustainable for me. With this in my mind, I enrolled in the OPOS initiate program to ease into a low-carb way of eating. The program was well-structured and not too difficult for me, but I was shocked and surprised by so many aspects of it (like giving up fruits, nuts and seeds), that I decided to delve into my own research. Several months of incessantly reading articles and watching videos by scientists with polar viewpoints, converged me to some beliefs and understanding of my own. I am still constantly experimenting with my own body and my food. While I think most doctors truly believe what they are saying, as a researcher myself, I could see how interpretation of some data and publication can be used to skew our conclusions based on our own biases. Of course, this applies to me as well in my ideas that I am writing here. And, most importantly, we have to look at which industry is sponsoring a particular research or symposium to even take the findings and skewed representations seriously. The best thing in today's world for us to do is experiment on ourselves safely.

I listened to a wide variety of doctors with extreme viewpoints (ex: vegan diet vs. carnivore diet), read some papers myself, and even non-medical practitioners like sadhguru Jaggi Vasudev. I was beginning a serious journey into health this time, and wanted to keep an open mind. Some of the youtube channels and doctors I listened mostly to: Dr. Jason Fung, Low-carb diet under, Diet doctor, Dr. Gundry's podcasts, Nutritionfacts.org, Dr. Pal, Eric Berg, Steven Ekberg and even Rujuta Diwekar. I also watched pretty much anything else that started showing up on my feed on health and nutrition by any certified doctor, and sadhguru Jaggi Vasudev. I also try to look up the referenced scientific literature where possible. I am  a lacto-vegetarian, who is a devotee of Kanchi Chandrasekhara Sarasawati (and give importance to his advice on food and eating habits which aligns with our traditional wisdom and the Bhagavad Gita). Why am I including spiritual gurus along with doctors? Despite working in science, from my observations so far, I see that age-old wisdom, particularly when it relates to health, is where science approaches after centuries of studies and millions of funded dollars. I also believe that food not only nourishes the body, but also the soul (and the western doctors or the OPOS mentors clearly do not consider such an aspect), and hence the nature (guna) of the food is as important as its chemical composition, macro and micro nutrient breakdown. 

So, what have I learnt so far, of which I am convinced at this time?

INSULIN! Everything I hear or read of late, starts and ends with insulin resistance. All metabolic related issues, such as diabetes, obesity, hypertension and chronic ailments are all related to insulin.  I understand now that insulin is basically a fat-storing hormone ("inhibits lipolysis" in medical terminology). Insulin also follows the circadian rhythm (sunrise to sunset cycle) and works at a lower efficiency after sunset.  Insulin is triggered when food touches our tongues, and to maintain good health, it is important to ensure that we do not keep insulin at a constantly elevated state (arising from eating at regular intervals). This leads to several problems arising from insulin resistance (diabetes/ hypertension/ arthritis) to eventual wear-out of our pancreas (a highly under-rated organ of our body).The insulin's first instinct is to get rid of all the excess blood sugar by pushing it into our cells. Over time, our cells become resistant to the actions of insulin (even a sponge can only hold so much water). So our bodies produce more and more insulin, as the cells become more and more insulin resistant. All this while, we do not suffer symptoms of lifestyle diseases. We would not be diagnosed as a diabetic. Eventually, the body stops producing all that insulin, because of the high insulin resistance, and then the excess blood sugar or other lifestyle diseases start showing themselves in our blood work. So, ideally we should be diagnosed a diabetic when we have high insulin levels, but a normal blood sugar. That would also be the easiest stage to reverse this. Unfortunately, even today, I have to argue with doctors for a prescription to check insulin levels.

But, what I have learnt over the course of this time is that each person's body responds differently to the same diet and lifestyle. While it may manifest as diabetes or obesity in some, it may manifest as joint pains or migraine in some others, and one root cause appears to be insulin resistance. The other major cause for malfunction and different responses in different people is our gut microbiome. I will talk more about gut microbiome in a subsequent post. Insulin resistance is only the tip of the iceberg. All hormones (ghrelin, leptin, cortisol, etc.) in our bodies follow circadian rhythms, and in the last few months I have felt that we need to align our habits to the circadian rhythms as well (more on this in another post), if we want to ensure that our hormones are not out-of-balance and not leading to lifestyle diseases.

Different types of food cause different hormonal responses within our bodies. Modern science breaks it down into the three macros: carbohydrates, proteins and fats. While carbohydrates produce the largest spikes of insulin, and fats the lowest, proteins generate an average response. So carb is the latest devil, while fats are now being celebrated again. But, really, is it all that simple?

Dietitians/ Nutritionists/ Trainers are increasingly moving out of the outdated "calorie-in calorie-out" theory when they talk about weight loss. Despite the "twinkie-diet", people acknowledge that foods of same calories trigger different hormonal responses within the body (common-sense?) and different foods also require different amounts of work/ energy from our body to digest. But, it appears that people do not apply the same common-sense (because the research is polarized, I suppose) when it comes to macros. There is a lot of talk about how all carbs are bad or all fats are bad, but unfortunately our human body is much more complex, and we are clearly a very long way away from really understanding everything about it. And, we will be at ends unless we look at nature first, how we fit into this nature and what effects they have on our minds and bodies. It is not a new fact that our minds can wreak havoc on our health (even certified doctors keep talking about managing stress- a highly simplistic term for the complexity of our mind, but still...). And, we know that our state of physical health plays a role on our minds. 

Diabetic patients will be given medicines to lower blood sugar (a classic addressing the symptoms, rather than the disease). Do the patients get better? No! Year after year of diligently following everything the doctor says, they stay sick and have to in fact slowly increase their dose of medication as well! So, are the medicines making them sicker? Being an arthritis sufferer myself, I can say the same about RA as well. Medicines (whether modern/ traditional) can only do so much to slow the progression of disease and offer temporary relief, but true change is not possible without diet and lifestyle changes. I have gone through several cycles of feeling better and feeling worse (and still do, due to a weak will power, and love for unhealthy food), and I have reached some understanding of what lifestyle habits trigger or alleviate certain symptoms. But, I am digressing. What does modern science say about these macros?

Encel keys appears to be the culprit (with allegedly corrupt agenda) when he demonized all fats and glorified carbs, with a very clear unethical misinterpretation of data that he collected. He is almost single-handedly responsible for the hole mankind has dug ourselves into over the last fifty years) He started off the low-fat high carb trend of foods, to the great profit of sugar industry and the junk food industry. People have gotten sicker and sicker in the last fifty years, but the food and pharma industries will have us believe that it has nothing to do with food. I now agree with the group that says fats are not the devil. What fats are OK, and in-fact essential for maintaining our body's balance? Again, the scientific community will break it down into saturated/ unsaturated/ polyunsaturated, short chain, medium chain long chain blah blah blah. You can find that information if you are interested, from better scientific sources than my blog. But, the biggest take away I converged on was that it is not only OK to eat some fats (not a lot as some extreme views suggest), but also essential for health, and some have done wonders to my body. A very simplistic abridgement of the detailed theses is that HEALTHY fats are essential to transport fat soluble vitamins (A, D, E, K), also help in triggering our satiety hormones while eating (and hence do not make us crave for junk food), keep us full for longer, and do not spike our insulin levels. Now, why is this last point important? This periodic spiking of our insulin levels is what leads to our energy patterns during the day. A heavy meal with lot of carbs and unhealthy fats make us drowsy. A light meal with a soup and salad keeps us light and alert. This is no secret. But, then we cannot sustain on soups and salads, can we? We will be hungry in no time. And that is the role of the healthy fat in keeping us satiated without affecting our energy levels.

The "fats are good" band also are usually part of the "carbs are all bad" band-wagon. Carbs can be simple or complex (pun intended) depending on how processed the food is. Broadly, we can classify them into resistant starches (potato family, raw banana, etc.), processed carbs (rice, wheat, flours), ultraprocessed carbs (anything packaged- biscuits, chips, bread, etc.) , vegetables, and fruits. 

Throw out the ultra processed carbs in your kitchen right now. Walk in there and throw it in the dustbin, and no arguments, if you want your health to take a turn for the better. I used to think I am only eating two biscuits in the morning and two in the evening, it is not such a big deal. Absolutely, it is a very big deal. First couple of days when I went without ultraprocessed foods (biscuits, etc.) were hard, then there were drug withdrawal like symptoms, and headaches and cravings, and even a disinterest to get out of bed! The sixth day was like magic! I will never forget it in my life! I woke up feeling ten years younger, with spirits of a five year old. That was my first step towards addressing the fatigue I mentioned in my prologue. Throwing out ultraprocessed garbage (not worth calling foods) did wonders.

Processed carbs is more tricky because they have become a staple of our diet. We do not know what to eat if we cannot eat rice, wheat or flours. What we can do is perhaps to eat the least processed version of these items (hand pounded rice, chakki atta, etc.). Here again, with just me as a data point, and some scattered literature to support it, I would say we should eat whatever grains are local to us. I was eating wheat in some form or the other (roti, upma, etc.) atleast one meal every single day 365 days of a year, thinking it to be totally healthy, but now I have come to believe it is not so. There may be two reasons for this, which is true, I am not sure. Firstly, wheat didnot come to south India until the great rice famine in the 60s. We are not genetically conditioned to process wheat at all. In the time scale of evolution, 60 years is perhaps equivalent to a micro second on a 24 hour time-scale. Secondly, today's wheat flour (packaged in a supermarket with infinite shelflife) is either genetically modified for being pest resistant, or has added gluten to increase shelf life. Research funded by organizations which are indirectly tied to the wheat industry will say that gluten allergy is a fad, and only patients with celiac disease need to avoid gluten. I disagree. Anything artificially modified against nature is something our body struggles to process.  I stopped eating wheat everyday. My joint pains disappeared in a week. While my RA has been more or less in remission, I had a wrist pain which varies in severity, but was always there the last thirteen years. A week of quitting wheat and refined oils (I will address this later), that wrist pain was gone..after thirteen years. My mother quit wheat, her sugar levels dropped. She gets tempted and eats wheat on one day. Next day, her sugar is up by ten points. If anybody who is reading this is an RA sufferer, you know what that joint pain is. Is the wheat worth all that!? I find that rice suits me better. I am probably genetically conditioned to process rice better. As I said in my prologue, this has to be a personal experiment for each person, but, most of us would not dream that wheat may be a culprit, as we have been brainwashed to think it is healthier by the wheat industry.

Fruits are tricky. I believe these are absolutely healthy when eaten in moderation, when we eat locally grown fruits, and preferably organic. Fruits we have today are not the same that grew fifty years ago. We have manipulated them to taste sweeter, look more vibrant, last longer, and they are heavy on a variety of pesticides. Some fruit varieties even have twenty or thirty different types of pesticides on them. This is to increase their lives from the farm to our homes in far-off cities. In Chennai, I may be better off eating bananas and coconuts, which are grown in every corner of the state, rather than eat something coming all the way from far off-places in the north, or worse "imported". But, pesticides apart, the arguments against fruits all revolve around fructose. Sugar typically consists of glucose and fructose. While glucose is sent into liver, muscles and our tissue cells, fructose is sent straight into the liver. The liver can only take so much and stores the rest of it as visceral fat. This visceral fat is supposedly the root cause of many of our problems. If you have a belly, you have visceral fat. We run into the danger of thinking of ourselves as thin or fat based on our overall body structures. But, of late, I realize how super skinny people also have a decent sized belly, meaning they have visceral fat, which impedes the functions of our liver, pancreas, kidney, and slowly lead to plaque accumulation in our arteries leading to the heart or brain, resulting in heart diseases and strokes. Few decades ago, the obvious rationale when some one is diagnosed with a liver disease is that they must be alcoholic. Today, the visceral fat that all of us have accumulated has led to the coining of a non-alcoholic fatty liver disease (NAFLD). This is usually undiagnosed, unless it is accompanied with other severe health conditions. But, it is a safe assumption to say that an obese person has NAFLD. So, one who is intent on reversing NAFLD, may do well to avoid fruits completely, until the condition has reversed. It will allow the liver to rest and heal. This has been a well documented diet change for NAFLD. For others, we can eat locally grown fruits in moderation, and preferably not after 4 PM. I will explain this in further detail in a subsequent post, but know that it ties to the circadian rhythm of insulin and its efficacy in processing certain foods after a certain time of the day.

Non-starchy vegetables are the best. Yes, they too have a ton of pesticides, but not only are they high in fiber, but they are also the most nutritionally dense food for vegetarians. Even a few keto-practitioner doctors (diet plan that denounces all carbohydrates) recommend not counting the carbohydrates from vegetables, as they are very close chemically to the ketone chemical formula (I do not want to go into the chemistry here). I eat plenty of vegetables, with no restriction, and I have not found any problems yet with this food group at all, either for me (with RA), or my mother (with diabetes).

Resistant starches are healthy if eaten in its unprocessed form. Potato is ok, not potato chips! We know this already, it is just a reiteration. The reason is not just because it is deep fried, but we are taking it farther and farther away from how we find it in nature. We are all a part of nature...we are all one living organism. Man made variations do not assimilate integrally into this as easily. No, what I am saying can be dubbed as utter nonsense by "pure scientists" or as "pseudo science". But, this is my experience, and one needs to experience this for oneself. Man made things in every aspect of our life has been slowly destroying the planet. Man-made food is not food. We fry things in oil, which is processed. We have, over the last few decades, started frying in refined oils, which are ultra-processed. It is mortifying to learn how refined oils are made. They are nothing but industrial waste, processed with de-odorizers, and deodorants, and flavor enhancers to make them edible. They donot have an immediate health reaction, but they are the worst things to consume. This is slow poison, and that is a fact that you can experience yourself. You like fried food? Fry it on rare occasions in unrefined (cold pressed/ virgin) oils or in ghee. An educated counter-argument is that we cannot fry in unrefined oils because the smoke point is too low, and the oil will decompose too quickly. Ghee has an extremely high smoke point, and can even be reused safely after frying once. Coconut oil is one unrefined oil which has a high enough smoke point to withstand frying. There may be others, but I am not aware of them. In a recent conversation with my father regarding this, he suddenly realized that my grandmother fried things only in virgin coconut oil in his childhood, but switched to refined palm oils, when they were marketed as being the healthier oil, and also made widely and cheaply available. The last point to remember when we talk about fried foods is this: remember that in our parents childhood, fried foods were usually home-made, and even then restricted to janmashtami, diwali and weddings. Today, these are available in every tiny box-shop in the country and made by frying in industrial waste, packaged with a list of ingredients that we do not even recognize. How were we brainwashed into thinking that nature (our wonderful human bodies) would seamlessly integrate this filth without repercussions?

And usage of refined oils is not restricted to deep frying, we have switched over to refined oils in every aspect (whether making sabjis, making chapati dough, or greasing our dosas).

Summary: Minimize processed foods, stop eating ultra processed foods, wheat and refined oils completely, cold turkey. Tell me you do not feel better in a month, and I would genuinely be interested in learning why.

In the next posts, I will talk more about essential fats, proteins, different diets that have seemingly reversed people's conditions, ayurvedic principles, and very importantly when to eat, and when not to eat. And, what role does our gut microbiome play in our health?