Wednesday, June 17, 2015

Essential Diabetes Leadership


“Why in this stultifying and needless conflict between reason and tradition, it should be so easy to believe the incredible and so difficult to accept the obvious, is a riddle which is not flattering to contemplate.”[1]
F. J.  COLE, 1944

In ESSENTIAL DIABETES LEADERSHIP (2011), the hypothesis and proof that a ketogenic—high fat, adequate protein, low-carbohydrate—diet for diabetics, as part of an overall BG optimization model, supports a long, happy, healthy life in general, I included specifics from six of the twelve total systems: the (1) circulatory, (2) digestive, (3) endocrine, (4) excretory, (5) nervous, (6a) skeletal (teeth), and (7a) integumentary (gingiva: the gums).[2]

Regarding the (5) nervous system, which includes the sense organs and vestibular system, the last endnote of the “Epilogue” provided supporting evidence for the use of a ketogenic diet in the successful treatment of epilepsy.  Since there’s more to the nervous system, and to the diseases of, than forty different kinds of epilepsy, this blog suggests a couple other information sources.

Reminiscent of Dr. Weston Price, we find a brave treatise written by another dentist.  First published in 2001, then condensed in 2005, ALZHEIMER’S SOLVED, by Dr. Henry Lorin, proffers a thoroughly researched theorem—his book references over 2,500 scientific articles—that better explains the data and observations than any other work on the subject: “It is indeed possible for a person to have blood cholesterol levels that are too low.”[3]  Reading through his manuscript, that conclusion is inescapable.

From aging to xanthomas, Dr. Lorin’s theorem in ALZHEIMER’S SOLVED unifies seemingly diverse conditions such as AIDS, Alzheimer’s disease, brain surgery, Cushing’s disease, dementia, depression, Down syndrome, epilepsy, head injury, HIV, osteoporosis, Parkinson’s disease, vasculitis, and others, with his remarkably simple deduction that amyloid—beta amyloid plaques—“is the body’s temporary substitute for cholesterol molecules.  Amyloid is to be used as a short-term ‘bandage’ for cell membranes until more cholesterol is provided.”[4]  Should that cholesterol, for whatever reason, be withheld, nearly all the aforementioned diseases inevitably become terminal.  Dr. Lorin summarizes his diet—beyond important micronutrients such as vitamin D—quite eloquently in one sentence: “The easiest and most natural way to do this [preventing and treating most of the described diseases] is by eating foods that contain cholesterol, while minimizing the consumption of foods that are primarily carbohydrates (starches).”[5]

You may also be interested in reading THE BRAIN TRUST PROGRAM (2007), by Larry McCleary, MD, which accessibly describes the important component parts of the nervous system, then delivers a striking contrast to all the also-ran diet-brain books published on how to best support them through diet.  Although he doesn’t outright advocate a low-carbohydrate diet, his 7-day menu plan sure does resemble one.[6]  A person with diabetes would simply need to skimp further on the fruit and minimal multigrain bread and crackers mentioned.

Here I could discuss the (8) muscular system in detail, but so much data exists on low-carbohydrate diets and exercise physiology, overlapping some with the (9) respiratory system—and I reprinted with permission much of the material written by Professor Emeritus Robert S. Horn on the subject in my first book—that, although tempting, I shall not rehearse the subject here, other than to say that Stephen D. Phinney provides great additional insight.

In “Ketogenic Diets and Physical Performance,” which contains many good sources for further reading, Dr. Phinney states in the Abstract that “impaired physical performance is a common but not obligate result of a low carbohydrate diet.  Lessons from traditional Inuit culture indicate that time for adaptation, optimized sodium and potassium nutriture, and constraint of protein to 15–25 % of daily energy expenditure allow unimpaired endurance performance despite nutritional ketosis.”[7]

And he concludes:

“Both observational and prospectively designed studies support the conclusion that submaximal endurance performance can be sustained despite the virtual exclusion of carbohydrate from the human diet.  Clearly this result does not automatically follow the casual implementation of dietary carbohydrate restriction, however, as careful attention to time for keto-adaptation, mineral nutriture, and constraint of the daily protein dose is required.  Contradictory results in the scientific literature can be explained by the lack of attention to these lessons learned (and for the most part now forgotten) by the cultures that traditionally lived by hunting.  Therapeutic use of ketogenic diets should not require constraint of most forms of physical labor or recreational activity, with the one caveat that anaerobic (i.e., weight lifting or sprint) performance is limited by the low muscle glycogen levels induced by a ketogenic diet, and this would strongly discourage its use under most conditions of competitive athletics.”[8]

Based upon Dr. Phinney’s work, my blood glucose model, of which I proudly presented in the chapter entitled “The Way Things Ought To Be (Part I),” recommended frequent, light exercise.

If you were thinking that I would now go over each of remaining five human organ systems (five because I’m including the skeletal system proper, the bones, and the integumentary system proper, the skin, hair and nails), I have a shocker for you: the medical literature world is predominantly data- and theorem-light—more, ignorant—about how macronutrients, not just vitamins and minerals, but how macronutrients—fats, proteins, and carbohydrates—and, specifically, a low-carbohydrate, medium-protein, high-fat diet, affect all but one of the remaining systems.

True, we know how the use of sugar per se affects nearly every organ system; two accessible books on the subject that you may find interesting are LICK THE SUGAR HABIT (2001) and SUICIDE BY SUGAR (2009), both by Nancy Appleton, PhD.[9]  By the way, these books remind me of an experiment on dogs performed by an ex-physician about two hundred years ago.  Let me share this brief story.

“In 1816, in an attempt to understand the biological value of certain foodstuffs, Francois Magendie—a child of revolutionary Paris and a former physician—set out to observe the effects of a restricted diet.  He was particularly interested in what role nitrogen has to play in digestion.  The answer he got back, after ten years of painstaking work was none at all: ‘As so often in research,’ Magendie wrote, with what bitterness we may imagine, ‘unexpected results had contradicted every reasonable expectation.’  But in the pursuit of this knowledge, Magendie had stumbled upon a striking, if unpleasant discovery: he had found that he was able to starve his experimental dogs to death on diets that should, on the face of it, have given them all the energy they needed for life.

By his own account, Magendie ‘placed a small dog about three years old upon a diet exclusively of pure refined sugar with distilled water for drink; he had both ad libitum.’  By the third week the animal, already weakened, lost its appetite, and developed small ulcers in the centre of each cornea.  The ulcers spread, and then the corneas liquefied.  Shortly afterwards, the dog died.

Magendie tried other nutritious foods.  ‘Everyone knows that dogs can live very well on bread alone,’ he confidently asserted—but when he put this to the test, he found that ‘a dog does not live above fifty days.’  The most calorific foods in Magendie’s pantry—wheat gluten, starches, sugar, olive oil—were not enough for life.  This was totally unexpected.  There was something missing—something available only as part of a varied diet—but what?”[10]

Turns out that it was vitamin A, isolated a hundred years later by two American teams, that was needed to keep the eyes from liquefying, though not enough to save the life.  The addition of whole milk to the diet saved the life; no, not of the dog, but of children, soldiers, waifs and strays suffering from xerophthalmia in the years preceding the isolation of vitamin A.  Of course, even then, experiments—on dogs, children, waifs, or strays—were not performed in the reverse to prove that you don’t need the sugar.  Carbohydrates have been considered essential since the dawn of agriculture.

“That transition from hunting and gathering to agriculture is generally considered a decisive step in our progress, when we at last acquired the stable food supply and leisure time prerequisite to the great accomplishments of modern civilization.  In fact, careful examination of that transition suggests another conclusion: for most people the transition brought infectious diseases, malnutrition, and a shorter life span.  For human society in general it worsened the relative lot of women and introduced class-based inequality.  More than any other milestone along the path from chimpanzeehood to humanity, agriculture inextricably combines causes of our rise and our fall.”[11]

Back to organ systems.  As I was saying, we know how sugar by itself negatively affects many organs and organ systems, but little is known about how any specific diet permutation affects the (7b) integumentary (skin, hair and nails), (9) respiratory, (10) lymphatic, (11) immune,[12] or (12) reproductive system.  Now, it surely can be inferred that, if we forgo the bolus insulin and carbohydrates, and eat just fat and protein, with type 1s only adding basal insulin, and we live a long, happy, healthy life, then all other organ systems must be doing just fine.  But such circumstantial evidence doesn’t necessarily prove that they’re healthy in the court of public opinion, let alone in science.  Unlike in evolution versus creationism, where, thankfully, evolution has been upholded,[13] no action has been brought against any carbohydrate-espousing proponent, by any low-carbohydrate proponent, in any jurisdiction.  Thus, we have no precedent, no ruling, no adjudication, based upon any evidence, for or against any diet, from any court of law.  Not that the vegans haven’t tried.[14]

We live today in an environment similar to that initially championed by John Washington Butler,[15] except, instead of its realization deriving from a law forbidding public school teachers from denying the Biblical account of man’s origin, we now navigate through an environment emotionally charged by a low-fat dogma; those that pray to it and live by its code do so influenced by the trinity of politics—playing into the public perceptions that they themselves or their forebearers created—faith and commerce, not science, serving it best by ensuring its promulgation into clinical practice guidelines, research, education, news and fixed media.  This dogma, however, unlike the Butler Act, is enforced not just in public schools, but across nearly all demographics.  Maybe by the time the 18th edition of this book is published, a precedent will be set upholding low-carbohydrate diets in a court of law, the above organ systems will be covered in more detail, and I will be able to provide a robust summary.

There is some information about how diet affects the (12) reproductive system, but most sources highlight the role of calories, not how any specific combination of macronutrients affects the reproductive system.  At first glance, learning that a low-carbohydrate, ketogenic diet led to significant improvement in weight, percent free testosterone, and fasting insulin in women with obesity and Polycystic Ovary Syndrome (PCOS) over a 24 week period, it sounds like we can put one in the win column for a low-carbohydrate diet best supporting the reproductive system.  Alas, PCOS is considered an endocrine disorder.[16]

Which really leaves only one organ system that I didn’t cover.  Well, half of one.

The (6b) Skeletal (bone) system, beyond studies about the correlation between osteoporosis and calcium, is supported by a low-carbohydrate diet in “The Effect of a Low-Carbohydrate Diet on Bone Turnover,” by J. D. Carter, F. B. Vasey, and J. Valeriano.  Here, the authors set out to determine whether or not a low-carbohydrate diet would lead to increased bone turnover.  Thirty patients (15 study subjects and 15 controls) were recruited for this 3-month study.  The 15 patients on the diet were instructed to consume less than 20 g of carbohydrates per day for the 1st month and then less than 40 g per day for months 2 and 3.  Control subjects had no restrictions on their diet.  And the conclusion?  “Although the patients on the low-carbohydrate diet did lose significantly more weight than the controls did, the diet did not increase bone turnover markers compared with controls at any time point. Further, there was no significant change in the bone turnover ratio compared with controls.”[17]

In what could be classified as the only compendium devoted to the relationship between the skeletal system and diet, NUTRITION AND BONE HEALTH (2004) doesn’t advocate any particular diet, although it does include an article—the book is a collection of independently written articles—describing both the plate model of the UK and the pyramid model of the US.[18]  The authors used these models as an assumption of diet; that, and a reference to fat leading to heart disease, without quoting any specific, credible evidence in defense of either.  As you read more and more health, diet, medical, reference books and articles, you’ll find support of those two concepts without evidence common faults.[19]  Mark Twain understated it best when he said “Be careful about reading health books.  You could die of a misprint.” 

However, if I could choose one quote from the book to best embody its entirety, it is that “bone health is not a mononutrient issue.”[20]  Some specific examples include:

·      “An inadequate intake of calcium and an inadequate level of vitamin D, alone and in combination, influence calcium-regulating hormone levels.  Deficiency of either nutrient results in reduced calcium absorption and a lower circulating ionized concentration.  The latter stimulates the secretion of parathyroid hormone (PTH), a potent bone-resorbing agent.  Over time, a small increase in the circulating level of PTH leads to measurable and significant bone loss and increased risk of fracture.”[21]

·     “Vitamin A deficiency is characterized by xerophthalmia, night blindness, cessation of growth, and increased susceptibility to infections.  On the other side, very vitamin A intake might affect, among others, bone and bone metabolism, as it has long been known.  High vitamin A intake seems to accelerate bone loss.”[22]

·  “Fluorine is an indispensable trace element and plays a role in normal development and maintenance of the skeleton and teeth.  As is true for other essential trace elements, deficiency or excess has clinical consequences: intakes below the recommended daily dose result in growth and development retardation, whereas long-term high intake leads to hyperostosis or even severe skeletal sclerosis.”[23]

Low-fat endorsing as it may be perceived, one article clearly supports the use of fat in promoting bone health: “Dairy products are complex, containing many essential nutrients, and thus their effects on bone health are likely more that can be accounted for by any single constituent and the totality of their effects may be more than the sum of parts.”[24]

But more interesting is the book’s discussion on fruits and vegetables:

·     “The approach of using food groups to examine the relationship between diet and disease is an appropriate and logical approach to examining the relationship between diet and osteoporosis.  There is somewhat remarkable agreement among countries as to the proportions with which we should be eating food groups.  The data suggest that milk and milk products (as providers of more than 50% of total dietary calcium) and fruit and vegetables are beneficial to bone health across the age ranges, although clearly more work on fracture reduction is required.”[25]

·  “Only two large population-based studies have examined the specific impact of dietary “quality”/food groups directly on indices of bone health, namely, the Aberdeen Prospective Osteoporosis Screening Study (APOSS) and the Framingham Offspring Study.  Cluster analysis on 904 women (mean age 54 yr.), pre-, peri-, and postmenopausal, showed that a number of food groups, including fried foods, cakes, processed meats, and puddings, were associated with worsening hip bone loss…”[26]

·   “These data support the findings of both the original APOSS baseline study and the older Framingham cohort and indicate that a high fruit and vegetable intake is protective to the skeleton, whereas high candy consumption is associated with lower bone mass, regardless of gender.  These data also suggest that a high intake of fatty, sugary foods is detrimental to bone health around the time of menopause.”[27]

This last quote conflicts with one of the most interesting cohort studies I’ve seen on the subject.  In “Food Choices and Coronary Heart Disease: A Population Based Cohort Study of Rural Swedish Men with 12 Years of Follow-up,” by Sara Holmberg, Anders Thelin, and Eva-Lena, the authors concluded: “Daily intake of fruit and vegetables was associated with a lower risk of coronary heart disease when combined with a high dairy fat consumption, but not when combined with a low dairy fat consumption.  Choosing wholemeal bread or eating fish at least twice a week showed no association with the outcome.”[28]

As with other nutritional controversies, we find the unifying answer to whether or not it’s fruits and vegetables per se or in combination with other foods that reduces heart or bone disease risk from Gary Taubes, and here he delivers the last words: “As a matter of logic, though, it doesn’t necessarily imply that the lack of vitamins are caused by the lack of fresh fruits and vegetables…It’s possible that eating easily digestible carbohydrates and sugars increases our need for vitamins that we would otherwise derive from animal products in sufficient quantities.”[29]  There is an increased need for these vitamins when more carbohydrate in the diet is consumed.”[30]

[1] In its original context, this quote refers to the 17th century comparative anatomist Tyson, who “Nevertheless after carefully reviewing the evidence which demonstrated conspiculously that the porpoise must be a mammal, Tyson nowhere has the courage to declare that it is not a fish, for once attaching more importance to habitat than to structure.  He says he should like to think it was a mammal, but further than that he did not go.”  See Cole, F.J.  A History of Comparative Anatomy: From Aristotle to the Eighteenth Century.  London: Macmillan & Co. Ltd., 1944, p. 202.

[2] There are three main approaches to studying anatomy: systemic, regional, and clinical.  Systemic anatomy is the study of the body as a series of organ systems. Although systemic anatomy textbooks typically cover all the human organ systems, they may group them differently, into from six to many more organ systems.  This grouping difference is based on writers’ specialty, preference and style, and editors’ formatting concerns.  Complicating the issue, some organ systems share significant functional overlap.  For instance, the nervous and endocrine system both operate via a shared organ, the hypothalamus; thus the two systems are sometimes combined and studied as the neuroendocrine system.  And the vestibular system, in fact all sense organs, are often covered in sections on the nervous system.  The musculoskeletal system combines two as one; textbooks frequently include the immune with the lymphatic system.

The publication of Andreas Vesalius’s De Humani Corporis Fabrica in 1543 ushered a new era in the history of medicine and marked the beginning of modern anatomy.  This first anatomy book of 659 pages detailed six human systems: (1) skeletal, (2) muscles and ligaments, (3) circulatory, (4) cerebral and peripheral nerves, (5) abdominal and thoracic organs, and (6) brain and organs of special senses.  See Persaud, T.V.N.  A History of Anatomy: The Post-Vesalian Era.  Springfield, IL: Charles C. Thomas Publisher, Ltd., 1997.

In the classic work Anatomy of the Human Body (Philadelphia: Lea & Febiger, 1918), Henry Gray (1827-1861, smallpox) posthumously grouped the various systems of the human body into the following six headings: “(1) Osteology—the bony system or skeleton, (2) Syndesmology—the articulations or joints, (3) Myology—the muscles.  With the description of the muscles it is convenient to include that of the fasciæ which are so intimately connected with them, (4) Angiology—the vascular system, comprising the heart, blood vessels, lymphatic vessels, and lymph glands, (5) Neurology—the nervous system.  The organs of sense may be included in this system, and (6) Splanchnology—the visceral system.  Topographically the viscera form two groups, viz., the thoracic viscera and the abdomino-pelvic viscera.  The heart, a thoracic viscus, is best considered with the vascular system.  The rest of the viscera may be grouped according to their functions: (a) the respiratory apparatus; (b) the digestive apparatus; and (c) the urogenital apparatus.  Strictly speaking, the third subgroup should include only such components of the urogenital apparatus as are included within the abdomino-pelvic cavity, but it is convenient to study under this heading certain parts which lie in relation to the surface of the body, e.g., the testes and the external organs of generation.”  The work, thoroughly revised and re-edited by Warren H. Lewis (New York:, 2000) is available online at

“The shortcomings of existing anatomical textbooks probably impressed themselves upon Henry Gray when he was still a student at St. George’s Hospital Medical School, near London’s Hyde Park Corner, in the mid 1840’s.  He began thinking about creating a new anatomy textbook a decade later, while war was being fought in the Crimea.  New legislation was being planned which would establish the General Medical Council (1858) to regulate professional education and standards.

Gray shared the idea for the new book with a gifted artistic colleague on the teaching staff at St. George’s, Dr. Henry Vandyke Carter, in November, 1855.  Neither was interested in producing a pretty book, or an expensive one.  Their purpose was to supply an affordable, accurate teaching aid for students like their own, who might soon be required to operate on soldiers injured at Sebastopol or on some other battlefield.  The book they planned together was a practical one, designed to encourage youngsters to study anatomy, help them pass exams, and assist them as budding surgeons.

The book Gray and Carter created, Anatomy: Descriptive and Surgical, published by JW Parker & Son, appeared in August, 1858, to immediate acclaim.”  (Condensed from Stranding, 2005, p. xvii).

The thirty-ninth edition of Gray’s Anatomy: The Anatomical Basis of Clinical Practice (Edited by Susan Stranding, et al., New York: Elsevier Churchill Livingstone, 2005), an enormous reference book consisting of 1,627 pages, “…is radically different from earlier editions because the body is described in regions rather than in systems.  In the real world, the editorial team for the 39th edition decided that a book which would be of the greatest benefit to practicing clinicians should mirror their daily practice and describe anatomy in the way in which they use it, i.e., regionally.”  However, it too describes six systems: the (1) nervous, (2) blood, lymphoid tissues and haemopoiesis (red and white blood cells), (3) musculoskeletal, (4) smooth muscle and the cardiovascular and lymphatic, (5) skin and its appendages, and (6) endocrine.  Basic structure and function of cells, integrating cells into tissues, embryogenesis, prenatal and neonatal growth are also covered.  Following the systemic overview, this compendium then describes seven sections: (1) neuroanatomy, (2) head and neck, (3) back and macroscopic anatomy of the spinal cord, (4) pectoral girdle and upper limb, (5) thorax, (6) abdomen and pelvis, and (7) pelvic girdle and lower limb.

A recent textbook, Principles of Anatomy and Physiology, by Professors Gerard J. Tortora and Bryan Derrickson (New Jersey: John Wiley & Sons, Inc., 12th edition, 2009) describes eleven systems of the human body: the (1) integumentary, (2) skeletal, (3) muscular, (4) nervous, (5) endocrine, (6) cardiovascular, (7) digestive, (8) urinary, (9) lymphatic and immunity, (10) respiratory, and (11) reproductive system.  In what seems like the authors proudly going the extra mile, this textbook advocates a high-carbohydrate, low-fat diet in support of optimum health: “…many experts recommend the following distribution of calories: 50-60% from carbohydrates, with less than 15% from simple sugars; less than 30% from fats (triglycerides are the main type of dietary fat), with no more than 10% as saturated fats; and about 12-15% from proteins.” (See page 1006).

[3] See Lorin, Henry.  Alzheimer’s Solved (Condensed Edition).  South Carolina: BookSurge, LLC, 2005, p. 5.

[4] Ibid, p. 94.

[5] Ibid, p. 225.

[6] See McCleary, Larry.  The Brain Trust Program.  New York: Penguin Group (USA) Inc., 2007, pages 97-93.

[7] See “Ketogenic Diets and Physical Performance,” by Stephen D Phinney.  Nutrition & Metabolism 2004, 1:2.  doi: 10.1186/1743-7075-1-2.  Available online at  Retrieved on 12/10/09.

[8] Ibid.

[9] Dr. Appleton lists “146 Reasons Why Sugar Is Ruining Your Health,” on her website at  Retrieved on 12/10/09.

[10] See Ings, Simon.  A Natural History of Seeing: The Art & Science of Vision.  New York: W.W. Norton & Company, 2008, p. 65.

[11] See Diamond, Jared.  The Third Chimpanzee: The Evolution and Future of the Human Animal.  New York: Harper Perennial, 1992, p. 139

[12] “Whether diet may influence autoimmunity has been the subject of many unsolved debates.  Interestingly, growing evidence indicates a large overlap between the mechanisms controlling tolerance to dietary antigens and autoimmunity.  See “Autoimmunity and Diet,” by Cerf-Bensussan N.  Nestle Nutr Workshop Ser Pediatr Program. 2009;64:91-9; discussion 99-104, 251-7. Available online at  Retrieved on 12/11/09.

The use of omega-3 polyunsaturated fat—fish oil—has been known in small doses to aid the immune system.  See “Dietary Fatty Acids and the Immune System,” by Calder PC.  Lipids 1999; 34:S137-S140.  Available online at  Retrieved on 12/13/09.

[13] As of 2009, proponents of evolution are 18-0 in US court cases.  Although State v. Scopes (1925), the first and most famous court case, resulted in a loss for Scopes, who was then fined $100, the verdict was eventually set aside due to a technicality on appeal to the Supreme Court of Tennessee.  The most recent case, Tammy Kitzmiller, et al. v. Dover Area School District, et al. (2005) was the first direct challenge brought in the United States federal courts against a public school district that required the presentation of intelligent design as an alternative to evolution as an “explanation of the origin of life.”  The plaintiffs successfully argued that intelligent design is a form of creationism, and that the school board policy thus violated the Establishment Clause of the First Amendment to the United States Constitution.  The Decision of the Court in the matter of Kitzmiller, et al. v. Dover Area School District, et al., is available online at  Retrieved on 12/10/09.  For good background information and further references, see  Retrieved on 12/10/09.

[14] In 2006, Wilson Elser attorneys won a significant victory in US District Court, Southern District of New York, by securing the dismissal of a case charging the Atkins book and food products were defective and dangerous under product liability laws.  The case involved a Florida man, and the lawsuit was commensed on the plaintiff’s behalf by the Physicians Committee for Responsible Medicine, which publically advocates a vegan (no meat, no dairy, no fish) lifestyle and has long been an opponent of the Atkins diet, attacking it as unhealthy.  Southern District Judge Denny Chin said the suit must be dismissed because the Atkins book and food products are not defective or dangerous under product liability law.  See the archives of the Wilson Elser Moskowitz Edelman & Dicker LLP law firm online at and  Both retrieved on 12/14/09.

[15] John Washington Butler (1875 – 1952) was an American farmer and a member of the Tennessee House of Representatives.  He is most noted for introducing the Butler Act, which prohibited teaching of evolution in public, i.e., state, schools, and which was challenged in the Scopes Trial.  The Butler Act was a 1925 Tennessee law forbidding public school teachers from denying the Biblical account of man’s origin.  It was enacted as Tennessee Code Annotated Title 49 (Education) Section 1922.  The law also prevented the teaching of the evolution of man from lower orders of animals in place of the Biblical account.  However, the law did not prohibit the teaching of evolutionary theory for other species of plants or animals.  The Butler Act was Introduced in the Tennessee House of Representatives as House Bill No. 185 by John Washington Butler on January 21, 1925; it passed the House on January 28, 1925 (Yeas: 71; Nays: 5); it passed the Senate on March 13, 1925 (Yeas: 24; Nays: 6); signed into law by Governor Peay on March 21, 1925; repealed on September 1, 1967 by Chapter No. 237, House Bill No. 48.  See the Wikipedia article titled “Butler Act,” available online at  Retrieved on 12/15/09.

[16] See “The Effects of a Low-Carbohydrate, Ketogenic Diet on the Polycystic Ovary Syndrome: A Pilot Study,” by John C Mavropoulos, William S Yancy, Juanita Hepburn, and Eric C Westman.  Nutrition & Metabolism 2005, 2:35.  doi: 10.1186/1743-7075-2-35.  Available online at  Retrieved on 12/10/09.

[17] See “The Effect of a Low-Carbohydrate Diet on Bone Turnover,” by J. D. Carter, F. B. Vasey, and J. Valeriano.  Osteoporos Int (2006) 17: 13981403.  doi: 10.1007/s00198-006-0134-x.  Available online at  Retrieved on 12/10/09.

[18] See “Food Groups and Bone Health,” by Susan A. New. In: Nutrition and Bone Health.  Edited by M.F. Holick and B. Dawson-Hughes.  New Jersey: Humana Press Inc., 2004.

[19] For a summary of the issues involved, see “Toward A Policy Agenda On Medical Research Funding: Results Of A Symposium,” by Robert I. Field, Barbara J. Plager, Rebecca A. Baranowski, Mary Anne Healy and Margaret L. Longacre.  Health Affairs, 22, no. 3 (2003): 224-230.  doi: 10.1377/hlthaff.22.3.224.  Available online at  Retrieved on 12/13/09.

[20] See “Sodium, Potassium, Phosphorous, and Magnesium,” by Robert P. Heany.  In: Nutrition and Bone Health.  Edited by M.F. Holick and B. Dawson-Hughes.  New Jersey: Humana Press Inc., 2004, p. 327.

[21] See “Calcium and Vitamin D for Bone Health in Adults,” by Bess Dawson-Hughes.  In: Nutrition and Bone Health.  Edited by M.F. Holick and B. Dawson-Hughes.  New Jersey: Humana Press Inc., 2004, p. 197.

[22] See “Vitamin A and Bone Health,” by Peter Burckhardt.  In: Nutrition and Bone Health.  Edited by M.F. Holick and B. Dawson-Hughes.  New Jersey: Humana Press Inc., 2004.

[23] See “Fluoride and Bone Health,” by Johann D. Ringe.  In: Nutrition and Bone Health.  Edited by M.F. Holick and B. Dawson-Hughes.  New Jersey: Humana Press Inc., 2004, p.345.

[24] See “Food Groups and Bone Health,” by Susan A. New. In: Nutrition and Bone Health.  Edited by M.F. Holick and B. Dawson-Hughes.  New Jersey: Humana Press Inc., 2004, p. 237.

[25] Ibid, p. 245.

[26] Ibid, pages 236-237.

[27] Ibid, p. 237.  See also the following: Macdonald HM, New SA, Grubb DA, Goloden MHN, Reid DM.  “Impact of Food Groups on Perimenopausal Bone Loss.”  In: Burckhardt P, Dawson-Hughes B, Heaney RP, eds.  Nutritional Aspects of Osteoporosis 2000 (4th International Symposium on Nutritional Aspects of Osteoporosis, Switzerland, 1997).  Challenges of Modern Medicine.  Ares-Serono, Academic, New York, 2001, pp. 399-408; Tucker KL, Chen H, Hannan MT, et al.  “Bone Mineral Density and Dietary Patterns in Older Adults: the Framingham Osteoporosis Study.”  Am J Clin Nutr 2002; 76:245-252; New SA, Bolton-Smith C, Grubb DA, Reid DM.  “Nutritional Influences on Bone Mineral Density: a Cross-Sectional Study in Premenopausal Women.”  Am J Clin Nutr 1997; 65:1831-1839; New SA, Robins Sp, Campbell MK, et al.  “Dietary Influence on Bone Mass and Bone Metabolism: Further Evidence of a Positive Link Between Fruit and Vegetable Consumption and Bone Health?”  Am J Clin Nutr 2000; 71:142-151; & Tucker KL, Hannan MT, Chen H, Cupples A, Wilson PWF, Kiel DP.  “Potassium and Fruit & Vegetables are Associated with Greater Bone Mineral Density in Elderly Men and Women.”  Am J Clin Nutr 1999; 69:727-736.  Op cit. ”Food Groups and Bone Health,” by Susan A. New. In: Nutrition and Bone Health.  Edited by M.F. Holick and B. Dawson-Hughes.  New Jersey: Humana Press Inc., 2004, p. 237.

[28] The authors followed coronary heart disease morbidity and mortality in a cohort of rural men (N = 1,752) participating in a prospective observational study.  Dietary choices were assessed at baseline with a 15-item food questionnaire.  138 men were hospitalized or deceased owing to coronary heart disease during the 12 year follow-up.  See “Food Choices and Coronary Heart Disease: A Population Based Cohort Study of Rural Swedish Men with 12 Years of Follow-up,” by Sara Holmberg, Anders Thelin, and Eva-Lena Stiernström.  Int. J. Environ. Res. Public Health 2009, 6, 2626-2638; doi: 10.3390/ijerph6102626.  Available online at  Retrieved on 12/13/09.

[29] See Taubes, Gary.  Good Calories, Bad Calories.  First Anchor Books Edition.  New York: Anchor Books, 2008, p. 322.

[30] Ibid, p. 325.  As it relates specifically to vitamin C, Gary Taubes states: “The vitamin C molecule is similar in configuration to glucose and other sugars in the body.  It is shuttled from the bloodstream into the cells by the same insulin-dependent transport system used by glucose.  Glucose and vitamin C compete in this cellular-uptake process, like strangers trying to flag down the same taxicab simultaneously.  Because glucose is greatly favored in the contest, the uptake of vitamin C by cells is “globally inhibited” when blood sugar levels are elevated.  In effect, glucose regulates how much vitamin C is taken up by the cells…In other words, there is significant reason to believe that the key factor determining the level of vitamin C in our cells and tissues is not how much or little we happen to be consuming in our diet, but whether the starches and refined carbohydrates in our diet serve to flush vitamin C out of our system, while simultaneously inhibiting the use of what vitamin C we do have.”