A young lady was sent to see me for chronic fatigue.  She has a normal weight and a normal body fat percentage.  Her blood work was unremarkable.  The only important past history is that diabetes runs in her family.  She also suffers some non-specific abdominal pain and occasional constipation.

Looking at her food diary, I found that she had been eating a very high carbohydrate diet.  She ate cereal, milk, yogurt, 4 serving of fruits per day and starches.  She said she felt tired an hour or two after she ate and that the tiredness improved with another meal.

I suspected that she may be suffering from a condition called “Reactive Hypoglycemia”.  When she ate a high carb diet, her blood sugar shot up and the body reacted by secreting a larger-than-necessary amount of insulin to bring the sugar back to normal.  Because of the diabetic gene, her body over-reacted to the high sugar, which led to low blood sugar one to two hours after she ate.  The low blood sugar led to the feeling of tiredness.   After she ate another meal full of carbohydrates, she felt better for a while, only to have another low later.

To test the theory, I asked the family doctor to order a blood test called the “5 hour glucose tolerance test”.  Her blood sugar will be measured by the laboratory every half an hour after the patient consumes a sugar loaded drink.  I told her to write down her energy level every time she had her blood drawn to see if the symptom correlates with the blood sugar values.  The treatment for this patient, if found to have reactive hypoglycemia, is to cut her carbohydrate and increase the protein content in her diet.

We stayed in Lyon, France for three days.  They (and we) had lots of Beaujolais red wine, cheese, bread, pork sausage and duck or chicken liver pate.  People here start drinking from breakfast until they sleep.  The local wine is milder than the ones we get in Canada.  They do spend their time eating slowly and enjoying their food, even for lunch.  Service is slow but no tipping is needed.  I tried a bit of everything here including the desserts, but with walking a few hours per day, I hope that I can burn it off.  We are going to Marseilles next and there will be l0ts of seafood there.

I have said that we should not have alcohol of any kind on phase one.  On Phase two we can have one serving of wine, hard liquor or a low-carb beer.  Most wine and hard liquor have little or no carbohydrate.  Alcohol is empty calories with no nutritional value.  Contrary to popular belief, drinking alcohol does not raise your blood sugar.  However, with the empty calories, it can cause weight gain.

Regarding beer, low-carb beer and light beer may not be the same.  Light beer usually means less alcohol.

Miller64 or Miller Genuine Draft Light has 64 calories per serving.  It has 2.4 g of carb and 2.4% alcohol.  Most regular beer has 4 % or more alcohol content.  It is suitable for the Phase Two diet.  Count as one of the two snacks that you are allowed per day.

There are also some sugar-free/light coolers which may also be suitable.

I have seen a few children with fatty liver disease lately.  A recent research article said that doctors can use fatty liver (from ultra sound or blood work) as a marker for the future risk of developing Type 2 diabetes.  As a matter of fact, liver specialists have begun to use Metformin (an antidiabetic medication) to treat fatty liver disease.  That means that there are common pathways between diabetes and fatty liver disease.  The most successful method to treat fatty liver is through weight reduction.  Losing weight with a low carb diet make a lot of sense in dealing with patients with diabetes or fatty liver disease.

All my young, obese patients, with abnormal liver enzymes, only get better with dieting.

It is highly unlikely that you will gain fat that quickly in this case.

You need to eat an extra 3500 kcal of food, to gain 1 pound of fat.  When you go off the diet, the first three pounds are usually water and glycogen (stored in your muscle and liver).  After the initial three pounds of water and glycogen gain, you will start to gain fat weight.

When you get back on the diet, the first thing you lose is going to be that water and glycogen.  You will only burn fat after the initial water and more importantly, glycogen, is lost.

There are so many reference values depending on your sex and race.  A simple rule of thumb is your waist should be less than 50% of your height.

This was what a patient asked me when she saw me drinking a diet coke.  Diet coke has zero calories; therefore, diet coke cannot cause weight gain by itself.  We cannot feed a starving population with diet coke and expect them to gain weight or not be hungry.  It does not happen that way.

What research showed in the past, was that the sweetness of the sweetener in diet coke can cause a rise in some people’s appetite.  When people overeat the wrong types of foods, they gain weight.  If you drink diet coke and eat the right types of foods, you will not gain weight.

Sugar-free does not mean carbohydrate free.  Baked potatoes are also sugar-free.  It is banned on this diet plan because of the starch content.  The starch molecule is comprise of many sugar molecules linked together.  When you eat starch, it breaks down into simple sugars before you absorb it in the small intestine.

When a dessert is labelled as sugar-free, it is likely full of starch, or fat.  If it does not provide you with nutrition information, it will be better if you don’t eat it.

If you are going to a buffet, the best thing is not to walk to the dessert section at all.  If anything, have a little bit of fruit.  At least that is phase 2!

Eat well and be happy.  It is the company and not the food that counts.

Drugs like Actonel and Fosamax are medications that are supposed to help postmanopausal females prevent bone fractures; however, they can actually cause fractures if the patient takes the medication for more than five years.  If the patient only has signs of osteopenia and not osteoporosis, this type of medication should not be used.  The treatment is worse than the disease.

Patients have to understand that osteopenia and osteoporosis are seldomly caused due to the lack of calcium in the diet.  The elderly lady in the nursing home will have osteoporosis no matter how much calcium and vitamin D supplementation we give her.  The most common cause of osteoporosis is the lack of weight-bearing exercise.

In the animal kingdom, most animals have to walk or run to look for food.  No animals need to drink milk or take calcium pills for their bones.  Yet, there is no known cases of osteoporosis in the wild animal.

When you put stress on the muscle, like doing weight training, your body will build more muscle.  If you put stress on the bone, like walking 30 minutes a day, your body will build stronger bones.