Replies

• Thinking about homeostasis and steady state dynamics, i think of the term metabolic recalibration as appropriate due to carbohydrate restriction healing.
  March 24, 2021

• I am not a physician but as an "educated" patient I can tell you the doctors I have consulted with are not operationally familiar with IR and much less with HOMA calculations. Most of the focus is on blood glucose which is elevated only in a fraction of patients and/or becomes sensibly elevated asa late sign. It has been hypothesized that it takes about a decade of chronic hyperinsulinemia/hyperglucagonemia before weight and blood glucose alterations become significant. It is still widely assumed that diabetes is a disease of hyperglycemia and not of hyperinsulinemia. Hence, most doctors do not measure fasting insulin because it is not a biomarker informing sugar status. I has taken redouble efforts for me to convince my endocrinologists to include fasting insulin among the markers to evaluate the status of my DT2. I wish we could have a continuous insulin tracking technology to better manage insulinemia.
  March 23, 2021

• Dr. Crofts and Kraft both mention that o ly 24% fall in pattern one. That the 2 hour GTT would catch 90% of patients. But I believe that the reason most docs don’t test is because they simply are ignorant to how to it’s used and why it even matters. Even my own sister(a fellow doc), when I asked her if she tests it came back to me and said “I don’t know how to use it” & “my patients wouldn’t do anything about it anyways” The lab values on the fasting insulin are ridiculous anyways. They believe it’s normal up to 25 anyways. We simply need to start educating our colleagues and teach them the value. But it’s concerning if we potentially could miss 76% of patients. Could it be that those patterns are inherent to our genetics? That the SAD diet would push them further to diabetes anyways? So everyone could benefit from a whole food diet anyway?
  March 17, 2021

• I'm going to answer my own question after listening to an excellent presentation by Dr Catherine Croft. The problem with fasting insulin testing is that insulin is a reactive hormone, it's not in a steady-state and is highly variable. This makes repeatability very challenging. When you look at different insulin measures, it's hard to achieve meaningful sensitivity and specificity. For this reason, performing a Kraft assay (2-hr insulin test after 100g oral glucose load) is preferred over fasting insulin.
  March 17, 2021

• Great find! If NAFLD is the #1 cause of needing a liver transplant then using metabolic therapy including carb appropriate diets to reversing NAFLD would be a great presentation for one of our practitioners (bariatric surgeon?) to make at some mainstream conferences. For example, presentation abstracts for APHA are due on 3/21. We have a clinician volunteer with experience picking speakers who might be able to give you pointers.
  February 27, 2021

• I'm so grateful that DD created TCR! At last, a legitimate medical nutrition therapy protocol to take the place of "keto," which has become a pretty controversial term. Being a dietitian, I instantly knew that your tweek of "restriction" to "reduction" was spot on. BTW In your Low Carb USA virtual talk introducing SMHP, you mentioned that there is a group of AAND RDs who are advocating to main-stream low carb. Is that group open?
  February 24, 2021

• Best wishes on this really important endeavor. We really need this new paradigm.
  February 17, 2021

• We have a fantastic searchable database right now, Liz. It is growing constantly so keep checking back to find someone in your area https://thesmhp.org/membership-account/directory/
  February 17, 2021

• I hope you will have a searchable data base soon. Please make it flexible so that we can find doctors in our area.
  February 17, 2021

• Wonderful!
  February 7, 2021