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glucose versus cholesterol optimization

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On 7/10/2021 at 6:50 PM, Dean Pomerleau said:

There is an entire thread on the topic of nut and calories:

--Dean 

Dean I would love to hear your take in general on the low fat heart disease reversal hypothesis that is supported by Ornish, pritikin group and Dr. esseltyne etc. assuming  of course that you have pondered this. Bottom line are fat sources like walnuts a heart healthy plus in your opinion which would contradict the likes of Dean Ornish etc. who insist low fat, 10-15% fat are indeed powerful medicine for reversal of coronary disease including limiting so called heart healthy fats. 

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Mike,

I don't have a strong opinion or insights into whether true low-fat or lowish-fat (using healthy nuts, seeds and avocados) is better for reversing heart disease. Based on the Ornish reversal study (albeit somewhat clouded by the addition of lifestyle interventions), my gut tells me that it is unlikely that a lowish-fat diet would be better than a true low fat diet for reversing heart disease. But neither would I be surprised if a lowish health-fat diet wasn't worse than true low fat. I think trying to say anything beyond that would be stretching the available evidence.

--Dean

 

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My choice is simple. To me it's easier to eat low carb than low fat. The VLF diet which ostensibly can manage blood glucose is not practical considering my lifestyle and my dietary habits.

I would also like to see the signal of a GCM in individuals eating VLF, with an abundance of cereals. 

On myself cereals in non-negligible amounts cause a prolonged increase in blood glucose, even if not a pronounced, spike or transient. The AUC of glucose concentration increases significantly anyway, potentially contributing to elevate the baseline.

The real challenge in a healthy lowcarb diet is to avoid animal fats (in my case, from dairy products and eggs).

 

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22 hours ago, Dean Pomerleau said:

Mike,

I don't have a strong opinion or insights into whether true low-fat or lowish-fat (using healthy nuts, seeds and avocados) is better for reversing heart disease. Based on the Ornish reversal study (albeit somewhat clouded by the addition of lifestyle interventions), my gut tells me that it is unlikely that a lowish-fat diet would be better than a true low fat diet for reversing heart disease. But neither would I be surprised if a lowish health-fat diet wasn't worse than true low fat. I think trying to say anything beyond that would be stretching the available evidence.

--Dean

 

Thank you Dean for your input. It is unfortunate that the data is scarce as far as any long term clinical trials

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I've taken my first step towards Glucose-cholesterol optimization.

Last year I remember my fasting glucose was at 85-90 mg/dL. Recently it raised to 100-105. A significant 15 mg/dL increase in the baseline which started to worry me, since FG is a usually stable baseline of the blood-glucose homeostatic system, sort of a setpoint whose upward variations may suggest something wrong going on.

So I installed a Continuous glucose monitor device (CGM), where I could see the effects of ripe fresh fruit eaten at the morning. I used to do that, eating just fruit at the morning since it's so easily digested. But this kind of meal results in a high glucose peak, which peters out after an hour but probably has a negative effect on me at this point. It was customary to me to eat large amounts of fruit in the morning alone since it is healthy food so easily digested. But this as I've observed mya have overly stimulated the pancreas beta cells.

I also observed the effects of a moderate-carbs diet, around 60-100 mg/dL of net carbs. It's not strictly low-carb, defined at 50 mg/dL, sure not keto, defined at about 20 mg/dL (these values may change individually fo course). Obviously, I didn't see spikes after eliminating honey, fruit, all simple sugars. I saw large humps with a prolonged effect when eating non negligible amounts of cereals though. So I discarded all cereals, eating only 50 grams of legumes, whose effect is negligible.

After 2 weeks of this moderately low carb diet my baseline decreased from about 105 to about 95 mg/dL.

My aim now is to go on as long as I can, at least a few months, after which I might resume a more various diet. I also must make the effort to reach enough calories not to loose weight, about 2700 seemingly.

This is an example of my daily regimen now.

  • Breakfast: cacao and nonfat yogurt or greek yogurt, with lowcarb dairy dessert, sometimes a few berries, 50 grams max but not always. Stevia/erithritol sweetener.
  • lunch/dinner: large dishes of salads and other vegetables with 40 grams hi-polyphenols EVOO, many nuts and seeds, a few legumes or nonfat cottage cheese or tofu, peanut butter, sometimes a little parmesan cheese, a lowcarb sweet at the end (quest bar, lowcarb chocolate). Sometimes some lowcarb product such as gluten pasta and so on.

This is the cronometer report for last week:

image.png.45f745c8b52677fb6b9a632834e74a78.png 58% fats, 20% carbs, 22% protein

Lipids composition: saturated fats are about 19% of total fats, this constitutes the cholesterol optimization.

image.png.ae57e0703074410ec105c2902f71b4ec.png

CArbs composition, cronometer slightly overestimates some carbs, I think the real number is about 10-20% less.

image.png.495c1b00d7449a8537ea6c0e6170edc3.png

 

Proteins are probably too many, I'll have to adjust but it's not easy when the choice is so restricted. My fasting IGF-1 and insulin are very very low, so it shouldn't impact too deleteriously on the overall health.

image.png.ee85b9620fca1d189bbd26d1639bbf79.png

All micronutrients are green bars, I make sure I take B-complex vitamins by ingesting 20-25 grams of nutritional yeast per day.

Edited by mccoy

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Thanks for the update mccoy. Nice experiment. 

If I were in your shoes I think I'd choose a different approach, finding a way to blunt the glucose spike after a fruit-only meal by mixing in some healthy fat and protein and especially by finding the time to exercise immediately after such a meal.

It will be interesting to see in a few months whether your ability to metabolize the glucose in carbs has improved or not after going low carb. And it will be interesting to see what happens to your cholesterol with all that dietary fat.

My speculation is that it would be a negative for your long-term health if you had to permanently eliminate so many healthy foods. 

--Dean 

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1 hour ago, Dean Pomerleau said:

If I were in your shoes I think I'd choose a different approach, finding a way to blunt the glucose spike after a fruit-only meal by mixing in some healthy fat and protein and especially by finding the time to exercise immediately after such a meal.

Dean, yes, it would be also useful to test different kinds of fruit, in combination with nuts or yogurt.  Or, for example, after a full meal (sliced banana with cacao powder). Moderation appears to govern as well. Fact is that, after a full breakfast I'm not so able to exercise efficiently, except for walking or household chores and gardening. Might contribute to the purpose but is not always possible due to my present workload.

1 hour ago, Dean Pomerleau said:

My speculation is that it would be a negative for your long-term health if you had to permanently eliminate so many healthy foods. 

That is my concern as well, this new regimen is probably not sustainable for a long time.

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I'm keeping up with the new low-carb regime. Cholesterol optimization involves eating loads of vegetables and nuts + EVOO,  oleic acid and phytosterols which are all supposed to be mild inhibitors of cholesterol synthesis, but I still eat some saturated fatty acids which may detrimentally impinge upon lipids balance. I can worry about it later.

One effect I think I'm experiencing is mild tiredness and sleepiness during the day. Maybe I should have been more gradual in the change, but momentum is momentum, I'm not missing at all carbs. Bodyweight has decreased but not much.

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This morning I measured my fasting BG by a strip glucometer, and it read 107 mg/dL.😬😬

Not very encouraging. I was expecting a decrease in the base level after about 3 weeks of low carb regime, although it may be a spurious number, I didn't repeat the measure but I'll do another measurement in a few days.

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This morning my BG is down to more encouraging territory, 93 mg/dL. The morning high values may be due to measurement errors or to unusual hormonal spikes (cortisol mainly, or glucagon, or norepinephrine or HGH or others). My dietary carbs levels are always in the region of 50-100 g/d-. Lactose and carbs from nonstarchy vegetables and nuts, mainly.

I'm losing some bodyweight though, that I hate. Hard to gulp down many calories when restricting both carbs and animal fats.

 

 

Edited by mccoy

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Today, after one month of the LCHF diet (average of 70-100 g/d net carbs), my fasting BG was 95 mg/dL, which suggests it has stabilized somewhat at minus 10 mg/dL with respect to the previous baseline. I was expecting a greater decrease though. I'm not suffering particular tiredness or lack of energy. Conversely, I do not feel better, stronger or more focused. Just about the same.

The diet is pretty boring, but not unhealthy, exception being made for some low-carb products which artificial sweeteners like quest bars, lowcarb protein desserts.

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hmmm... McCoy said: The diet is pretty boring, but not unhealthy. Referring to THE LCKD. The below paper casts serious doubt on that conclusion.

This paper takes a look at the only studies, which have looked at the impact of LowCarb-Ketogenic diets (LCKD) on these blood tests and corresponding changes in CAD.

While the medical and lay literature would suggest considerable information has been obtained as to the effect of LowCarb-Ketogenic diets - the opposite is true. There are only three published studies, which have measured the actual impact these diets have on the coronary arteries (CAD). These studies have admittedly used the semi-quantitative methods available at the time of their investigation. 

Before people are told that LowCarb-Ketogenic diets are safe, harmful, or have no impact on heart disease – independent of their effect on weight change and blood test results – given what we know about the semi-quantitative measured changes associated with these diets, we need to first objectively measure the true effect these diets have on the arteries of the heart with FMTVDM. Then and only then will we be able to intelligently, objectively, advise patients – and the media - about these diets and their consequential impact on coronary artery disease; the number one cause of death in men and women.

Of great concern are the recent comments made by LCKD pundits claiming that patients with lower LDLc levels are at an increased risk from CoVid-19 infections and that the use of ketogenic diets are somehow protective against CoVid-19. These statements are not only scientifically unproven but also potentially quite dangerous given the measured worsening of comorbid states like CAD associated with people following these diets. Such unsubstantiated claims are concerning.

 

 

Edited by Mike41

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Mike, I read that article but I found no details on the diets being studied, except macros and calories. That's not enough to label a diet, as we all know.

Usually, LC-KDs are made up of meat and fish, eggs, very fat dairy products, nonstarchy vegetables. There are very few keto diets with an emphasis on plant-based food.

In addition, in my personal case, I'm far from following a keto diet, which usually entails a 20-30 grams max of daily intake of net carbs.

My intake is more in the range of 75 grams per day, which would classify it as a relatively low carb diet. Plus I'm eating mounds of vegetables raw and cooked, with lots of fiber, at least 60 grams per day, plus a little legumes, tofu and foods which are considered to be healthy by all except the usual vegan doctors: seeds, nuts, EVOO.

The unhealthy part is the Quest bars, the artificially sweetened drinks, which I take in moderation, and possibly the high amount of protein, which I cannot avoid and besides should prevent me from losing significant weight. Blood cholesterol is usually associated with the intake of saturated animal fats, which I'm eating in low amounts.

 

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1 hour ago, Mike41 said:

This paper takes a look at the only studies, which have looked at the impact of LowCarb-Ketogenic diets (LCKD) on these blood tests and corresponding changes in CAD.

Wow Mike. That paper is a gold mine - actually the gold mine is the third study [1] the author talks about (and was author on). It is a one year dietary intervention where 120 obese subjects were asked to follow one of three low calorie diets - Low-Carb Ketogenic Diet (LCKD - 50+% fat), moderate fat (26%), or low fat vegan diet (< 20% fat). Here is the dietary advice the three groups were given:

Dietary Advice (instruction)

Those following the vegan (Veg) diet were asked to abstain from

eating meat, which was defined as anything moving under its own

power while alive (e.g., beef, poultry, pork, fish, et cetera). Dairy

products and eggs were also eliminated from the diets of this group.

Recommended sources of protein included legumes, beans, nuts and

soy products. Fats were limited to those found in vegetable sources and

oils used in the preparation of foods as well as flaxseed.

 

Low to Moderate Fat (LMF) diets included adjusting the fat intake to

no more than 15-20% of the total caloric intake. No specific foods were

eliminated on this diet as long as the total fat intake did not exceed this

amount with no more than 5 grams of saturated fat consumed per day.

During a typical day this would result in 20-25 grams of non-saturated

fat and up to 5 grams of saturated fat. Meats (defined as anything

which moves under its own power when alive) were incorporated into

this regimen with limitations based upon the saturated fat content.

Hence, preparation of meat products focused on removing as much

saturated fat from the products as possible. Dairy products were limited

on the basis of fat content, with emphasis on skim milk and skim or

soy milk products.

 

Lowered Carbohydrate (LoCarb) diets were defined as diets where the

consumption of carbohydrate did not exceed 25% of the recommended

daily caloric intake which equaled approximately 100 grams per day.

The remainder of the caloric intake was divided between protein (25%)

and fat (50%) consumption. There were no restrictions on the amount

of saturated fat versus non-saturated fat consumed. Selection depended

upon personal preference.

 

All individuals were instructed on caloric intake providing 1500 to

1600 kcal/day, including instructions to avoid eating within 4-5 hours

of going to sleep.

 

Compliance was surprisingly good, as measured by the respiratory quotients of the three groups. All three groups lost about the same amount of weight ~30lbs - quite impressive. The results of the low-fat vegan diet and moderate fat diet were pretty similar and quite beneficial. But the LoCarb group actually got worse or at least didn't improve on most of the blood markers of heart disease despite all the weight loss. But most importantly, the coronary blood flow got better on the first two diets and got substantially worse on the LoCarb diet. Here is the main figure from the paper, comparing the results of the three diets on all the important markers:

Screenshot_20210731-170750_Drive.jpg

Sorry it is so small. The top row in each square is moderate fat, the middle row is LoCarb and the bottom row is vegan. 

Pretty dramatic. Mccoy is right that the LoCarb group probably ate a lot of saturated fat and animal products. But unlike him, that is what a lot of LoCarb folks eat when they go on the diet.

--Dean

--------------

[1] Edel J Biomed Res Rev 1: 21-30. (2019)

Cardiovascular Outcomes of Diet Counseling.

Fleming RM, Fleming MR, Chaudhuri TK, Harrington GM

Full text: http://edelweisspublications.com/edelweiss/article/cardiovascular-outcomes-diet-counseling-bmr-19-108.pdf

Abstract
Context: The leading cause of death in the U.S. is heart disease with obesity as the major correlate and, some believe, 
Cause: Obesity is caused by eating behaviors. The U.S. Preventive Services Task Force notes the need for, yet absence of, randomized controlled 
trials of behavior modification interventions for cardiovascular disease endpoints.
Objectives: To modify habitual dietary behaviors with counseling, to assess retention of the resulting habits, and to compare cardiovascular 
effects of such modifications under diets differing in fat content.
Design: One-year randomized controlled trial of three diet behavior interventions for cardiovascular and behavioral end-points with intermediate 
surrogate end-points enabling intent-to-treat analysis. 
Setting: Prairie States private cardiology practice.
Participants: One hundred and twenty referrals screened for: cardiovascular co-morbidity, heart medication, and informed agreement.
Intervention: One hour of diet protocol initial individual instruction and one half-hour of individual self-efficacy counseling every six weeks 
thereafter for one year.
Main outcome measures: The primary cardiovascular measure was SPECT device measured physiologic coronary blood flow. Retention of 
modified habits was assessed with four-month post-study measurement of changes in Respiratory Quotient as a menu selection index and in Body 
Mass Index as a portion control index. Surrogate endpoints were weight, BMI, lipids and other standard blood chemistry indices.
Results: Participant attrition, zero. Changes in coronary blood flow were correlated with diet protocol, R (95%CI)=0.48 to 0.69, p=2.4 x 10-12

Ischemia improved significantly under a lowered fat protocol and worsened significantly under lowered carbohydrate conditions. Surrogate 
endpoints, weight and blood chemistry, showed similar correlations, p<10-11.
Four months post-study, lowered fat dieters had retained their 
intervention modified behaviors while lowered carbohydrate and vegan dieters had changed, R (95%CI)=0.53 to 0.74, p=2.5 x 10-14 for portion control and R (95%CI)=0.76 to 0.88, p<2.2 x 10-16 for menu selection.

 

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10 hours ago, mccoy said:

Today, after one month of the LCHF diet (average of 70-100 g/d net carbs), my fasting BG was 95 mg/dL, which suggests it has stabilized somewhat at minus 10 mg/dL with respect to the previous baseline. I was expecting a greater decrease though. I'm not suffering particular tiredness or lack of energy. Conversely, I do not feel better, stronger or more focused. Just about the same.

Interesting, although well within the margin of error of the device.

I personally am more inclined to believe that insulin resistance is the result of high fat intake, so I would stay away from fat and stick to high carbs from unprocessed whole foods.

Are you spot-checking with finger-pricks regularly?

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Dean Pomerleau wrote:

“Wow Mike. That paper is a gold mine - actually the gold mine is the third study [1] the author talks about (and was author on). It is a one year dietary intervention where 120 obese subjects were asked to follow one of three low calorie diets - Low-Carb Ketogenic Diet (LCKD - 50+% fat), moderate fat (26%), or low fat vegan diet (< 20% fat). Here is the dietary advice the three groups were given”


Hi Dean may I get your opinion on this study and ask you if you feel this adds support for the Dean Ornish (whose dietary program is paid for by insurance companies) Esseltyne and Pritikin studies that all showed reversal of CAD Patients who followed low fat vegan diets? 

Edited by Mike41

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1 hour ago, Mike41 said:

Hi Dean may I get your opinion on this study and ask you if you feel this is strong support for the Dean Ornish (whose dietary program is paid for by insurance companies) Esseltyne and Pritikin studies that all showed reversal of CAD Patients who followed low fat vegan diets?

Hi Mike,

I'm actually somewhat suspicious of the results of this study. These were quite obese subjects (avg BMI=42) who were counseled every six weeks about how to stick with a 1500-1600 kcal diet that was low-fat vegan, low-moderate fat or low carb. They claim zero attrition and good compliance among 120 subjects over the course of one entire year. But they don't provide any data in the paper about what the people actually ate (i.e. based on diet logs or food frequency questionaires). That raises my suspicions, as does the fact that the lead author also has a patent and a book on the "FMTVDM" methodology employed in the study, which stands for "Fleming Method for Tissue and Vascular Differentiation and Metabolism." From the book blurb:

 This book does NOT entitle the reader to conduct FMTVDM tests. That requires a license (patent # 9566037) which can only legally be obtained from the author.

That sort of posturing makes me think this Fleming guy may have more of an agenda than pure science. Plus the journal it is published in (Edelweiss Journal of Biomedical Research and Review) is not a top notch journal. It has only been in existence since 2019, has only ever published a total of 20 articles, one of which is titled Masking Tape Art-Work May Provide Beneficial Positive EffectsNote the redundancy in the title. My thinking is, if this study is so important why would it end up in such a third-rate journal and not someplace like The American Journal of Clinical Nutrition? Something smells fishy.

Without knowing what they actually ate or having a lot of trust in the source, I'm hesitant to put too much stock in it.

Plus, the "low to moderate fat (LMF) diet" group did as well as the low-fat vegan group. The LMF group was instructed to keep their fat percentage in the 15-20% range, but we can't tell if they actually did, and given no additional information, it seems unlikely. More likely they were in the moderate fat range of 25%. The so-called low fat vegan group was explicitly told nuts were a good protein source and told "Fats were limited to those found in vegetable sources and oils used in the preparation of foods as well as flaxseed." That seems pretty darn vague and could be easily interpreted to mean oils are ok. Note there was apparently no explicit instruction to limit (vegan) fats or about how much fat to consume, only that it must be vegan. So the low fat vegan diet may not have even been low fat. 

So if you take this study at face value, the apparent success in reversing the evidence of heart disease in both these groups would suggest to me that demonizing of (vegetal) fats by the Esseltyn and Pritikin crowd may be a lot of hot air.

 --Dean

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12 hours ago, Ron Put said:

Are you spot-checking with finger-pricks regularly?

Ron, I'm no more wearing a CGM, since I know that the meals I'm eating now do not result in glucose peaks.

What I'm doing is to check my fasting BG with finger pricks about twice a week. The device is an Aviva Accucheck with a reported MARD of 7%. Better than that, AFAIK, there is the Freestyle Abbot device with a 4% MARD. Maybe I'm going to indulge my present BG obsession and purchase it. Some people like faster cars, some others prefer more accurate glucometers!

Edited by mccoy

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7 hours ago, Dean Pomerleau said:

Plus, the "low to moderate fat (LMF) diet" group did as well as the low-fat vegan group. The LMF group was instructed to keep their fat percentage in the 15-20% range, but we can't tell if they actually did, and given no additional information, it seems unlikely. More likely they were in the moderate fat range of 25%. The so-called low fat vegan group was explicitly told nuts were a good protein source and told "Fats were limited to those found in vegetable sources and oils used in the preparation of foods as well as flaxseed." That seems pretty darn vague and could be easily interpreted to mean oils are ok. Note there was apparently no explicit instruction to limit (vegan) fats or about how much fat to consume, only that it must be vegan. So the low fat vegan diet may not have even been low

So Dean I take it you are not impressed with the following measurements to determine compliance? As far as I can tell it does not appear that RQ COULD ACCURATELY PREDICT THE TOTAL FAT IN A DIET, BUT I AM NOT AT ALL FAMILIAR WITH IT. 
 

In addition to dietary counseling and measurement of compliance with dietary counseling through the use of urine ketone testing and measurement of respiratory quotients (RQ), half of each dietary group was provided with a B-6, B-12, folate supplement, to assure adequate intake independent of any potential dietary limitations – which had been suggested by previous studies [27,28].

The respiratory quotient (RQ or respiratory coefficient) is a dimensionless number used in calculations of basal metabolic rate (BMR) when estimated from carbon dioxide production. It is calculated from the ratio of carbon dioxide produced by the body to oxygen consumed by the body. Such measurements, like measurements of oxygen uptake, are forms of indirect calorimetry. It is measured using a respirometer. The respiratory quotient value indicates which macronutrients are being metabolized, as different energy pathways are used for fats, carbohydrates, and proteins.[1] If metabolism consists solely of lipids, the respiratory quotient is approximately 0.7, for proteins it is approximately 0.8, and for carbohydrates it is 1.0. Most of the time, however, energy consumption is composed of both fats and carbohydrates. The approximate respiratory quotient of a mixed diet is 0.8.[1] Some of the other factors that may affect the respiratory quotient are energy balance, circulating insulin, and insulin sensitivity

Edited by Mike41

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On 8/1/2021 at 10:43 AM, Dean Pomerleau said:

Something smells fishy.

I'm pleased to report that my bullsh*t detector is well honed. I looked up the author (Richard M. Fleming). It turns out he's been convicted twice of fraud. And the paper in question has been published and retracted in a respectable journal, and has since been published at least two more times (now three with the Edelweiss version). Here are several articles on the sordid details if anyone is interested in going into the weeds on this crap:

The FDA has debarred Fleming:

https://www.federalregister.gov/documents/2018/09/28/2018-21210/richard-m-fleming-denial-of-hearing-final-debarment-order

The reason he was debarred was two felony convictions for healthcare fraud, in particular lying to (and billing) insurance companies for medical tests he didn't perform and for a fake study he claimed to have conducted (for a large fee) for a soy food product company that wanted to make a health claim:

https://archives.fbi.gov/archives/omaha/press-releases/2009/om082009.htm

Here are several takedowns of previous published versions of this same paper, raising several of the concerns I did above and quite a few others:

https://scienceintegritydigest.com/2019/06/23/three-diets-three-papers-one-retraction-and-lots-of-concerns/

https://pubpeer.com/publications/A8C354136E027DDE273014A44BF20E

Here is the most entertaining takedown because of the comment thread at the bottom. So called "Dr." Fleming engaged in quite the back-and-forth with his critics, which he apparently later deleted, likely for legal reasons:

http://hopefulgeranium.blogspot.com/2018/09/egregious-richard-m-fleming-story_30.html

Quite amusing. Suffice it to say that you should ignore the study in question.

--Dean

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On 8/1/2021 at 8:14 AM, mccoy said:

Maybe I'm going to indulge my present BG obsession and purchase it. Some people like faster cars, some others prefer more accurate glucometers!

Haha! Actually, I've been thinking of asking my doctor to write me a prescription for a continuous monitor, just to indulge my curiosity. More information is never a bad thing and v3 which just came out last year is supposed to be considerably more accurate than the previous iterations.

On the other hand, until I took Berberine for three months my fasting glucose readings were always in the 80s, with one low 90s if I recall. Since I stopped Berberine it has gone back to 84. Also, for what it's worth, according to SelfDecode's blood sugar report based on my genetic data, I am in the 3rd percentile of the population for risk of developing diabetes.

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