As I thought about what was happening with the "Dawn Effect" (if in fact that was what was going on) I was curious about the impact it would have on my HbA1c. I could conceive of ways that it might rise a bit and of other ways it could drop. My inclination is it would drop. It had been a month since I had checked my HbA1c and a lot of medical professionals will say you don't need to check that often because the A1c test reflects blood sugar levels over the past 2 to 3 months.
Well, I disagree - saying the A1c test reflects the past 2-3 months is just a piece of the truth. The test measures how much of a glycolated protein there is on a person's red blood cells. Red blood cells can live up to 3 months, hence the medical (and insurance) profession's comments. In reality, most of them are shorter lived and HbA1c can change significantly in just a month. So I retested using the Bayer home test and the result was 5.5%, which is an excellent reading (borderline normal).
As I keep studying the data, I am beginning to believe it takes the body 3 weeks or more after stopping a drug to remove the drug and its metabolites and stabilize again without the drug. I've seen this now with Actos, Metformin, and Exforge (a blood pressure drug). Most of the literature you'll find speaks of a half-life that is much shorter, measured in hours or days and never weeks. The may be true at some level if you're measuring blood chemistry. When you look at the time it takes the body to clear a drug AND return to normal, my experience is 2-1/2 to 4 weeks seems to be what it takes.
So the summary to date after 17 weeks of eating for nutrition and exercising both aerobically 3 times/wk (for about 12 wks) and anaerobically 3 time/wk times (starting July 5) are:
38 pounds lost.
45 mg/d of Actos eliminated
All other meds cut by 50%
Blood pressure typically runs 125/70 or less
Total cholesterol: 125
Fast blood sugars are current running 127 mg/dl (and appear to be dropping at 4 mg/dl per week)
My current fasting blood sugar readings are 51 points lower than when I started the program. If I add in the estimated reduction that the Actos and metformin were doing my blood sugar drop is probably between 80 and 100 mg/dl lower than when I started.
I've got 37 more pounds to lose. If the trend lines continue I should be able to control my diabetes with diet alone comfortably in another 10 to 12 weeks (estimate); maybe a bit less. There is no doubt in my mind that I could be "diet controlled" and meet the FAA's requirements for passing a flight physical (HbA1c <9.0). The trouble is, there's too much data that says keeping your A1c low reduces complications from diabetes. The popular simplistic value is 40% fewer complications for every 1% reduction.
When my fasting blood sugar readings are less than 115 and stable, I'll drop my metformin dosage to 500 mg/d. Then I wait and see what happens. I'd like to see my fasting blood sugar under 110 to quit taking metformin. Ideally, I would like to see this happen when I weigh between 205 and 210. Given the current trend line, this seems plausible. Time will tell.
Saturday, July 23, 2011
Wednesday, July 20, 2011
First Stumble
Since the end of March I have been losing between 1.5 and 3.4 pounds per week, every week and averaging a 2.3 pound/week loss. My goal was and continues to be 2.0 pounds per week. There has be a constant but variable drop in blood sugar along the way. The only exception to the drop in blood sugar was when I went off Actos and there was a moderate (15-10 mg/dl) rise. Last week my fasting blood sugar levels started to rise without apparent cause. Two weeks ago my weekly average fasting blood sugar was 117 and dropping 3 to 4 mg/dl every week. Last week my fasting blood sugar was 131.
When I looked for an explanation there were no obvious causes. The change in eating habits was bringing me in line with my ideal weight (i.e., I was losing weight). My exercise plan which seemingly was accelerating the loss a bit was steady, ongoing and seeming to work both building new muscle and increasing stamina. I noticed I had a little congestion. It could have been pretty much anything - an allergy to rising pollen counts or perhaps a summer cold starting up.
I didn't expect the numbers to stay up for very long. About 10 days later they seem to be coming down slowly but I may have discovered the issue. I say "may" because I'm not certain. I have checked my blood sugar during the night and it seems to be between 112-118 until 4:00 or 5:00 am when it starts to rise a little. This is called the "Dawn Effect" and apparently your body is getting ready for you to become active again. Part of the process involves the liver releasing glycogen, which becomes two glucose molecules in the blood. This is energy that's waiting for the body to start to work.
If I've nailed the problem down, I'm not too concerned. My HbA1c will continue to drop but my baseline for evaluating my progress has changed. This is a mixed blessing - it might be good or it might be bad. I'm looking at it as a way to get my fasting blood sugar levels even lower and will monitor my "rising blood sugar" - meaning both when I rise and the fact that the level has risen above the fasting level. My goals remains the same: I want my morning blood sugars under 100 as soon as possible and then I want them under 89. Ideally these numbers will be without medicine.
If there was a way to get my body to extend the low fasting blood sugar levels that would be great. I'm looking to see if there is a way that isn't 'trickery', like having a high carb snack late at night. Building new muscle should increase my metabolism and might reduce my insulin resistance. Logically, this should lower my fasting blood sugar levels. Aerobic exercise burns fat which improves insulin efficiency and this too should lower my fasting blood sugar levels. Good nutrition seems to help and perhaps over time as the body renews itself, my liver and pancreas can improve their insulin sensitivity and production, too.
When I looked for an explanation there were no obvious causes. The change in eating habits was bringing me in line with my ideal weight (i.e., I was losing weight). My exercise plan which seemingly was accelerating the loss a bit was steady, ongoing and seeming to work both building new muscle and increasing stamina. I noticed I had a little congestion. It could have been pretty much anything - an allergy to rising pollen counts or perhaps a summer cold starting up.
I didn't expect the numbers to stay up for very long. About 10 days later they seem to be coming down slowly but I may have discovered the issue. I say "may" because I'm not certain. I have checked my blood sugar during the night and it seems to be between 112-118 until 4:00 or 5:00 am when it starts to rise a little. This is called the "Dawn Effect" and apparently your body is getting ready for you to become active again. Part of the process involves the liver releasing glycogen, which becomes two glucose molecules in the blood. This is energy that's waiting for the body to start to work.
If I've nailed the problem down, I'm not too concerned. My HbA1c will continue to drop but my baseline for evaluating my progress has changed. This is a mixed blessing - it might be good or it might be bad. I'm looking at it as a way to get my fasting blood sugar levels even lower and will monitor my "rising blood sugar" - meaning both when I rise and the fact that the level has risen above the fasting level. My goals remains the same: I want my morning blood sugars under 100 as soon as possible and then I want them under 89. Ideally these numbers will be without medicine.
If there was a way to get my body to extend the low fasting blood sugar levels that would be great. I'm looking to see if there is a way that isn't 'trickery', like having a high carb snack late at night. Building new muscle should increase my metabolism and might reduce my insulin resistance. Logically, this should lower my fasting blood sugar levels. Aerobic exercise burns fat which improves insulin efficiency and this too should lower my fasting blood sugar levels. Good nutrition seems to help and perhaps over time as the body renews itself, my liver and pancreas can improve their insulin sensitivity and production, too.
Saturday, July 9, 2011
Weekly Assessments
It's Saturday and this is the day I evaluate my progress. It is also a full week (8 days actually) on a 50% in metformin. I figured I should be seeing the impact of taking less medicine to control my blood sugar.
So, before I get into the numbers, let me explain what numbers I track and how I track them...and maybe a bit about why I track them. The "how" piece is actually important, and I think a bit interesting - feel free to disagree.
Every morning when I get up (and the time does vary by a few hours some days) I check my fasting blood sugar and my weight. The fluctuate from day to day so trends are not always clear. I try to check my blood sugar before lunch and dinner and 2 hours after eating as well as before I go to bed. My blood sugar meter automatically calculates 14 and 30 day averages for all of the readings I collect. The fact is I have 3 meters and only one of them does the averaging. One meter is at work and the other is near where I eat.
My fasting blood sugar and three or four other readings are generally taken on the averaging meter. My methodology is not terribly consistent and therefore may not be scientifically reproducible but the trend line for both the 14 day and the 30 day readings has been steadily down. The 14 day and 30 day averages were 178 and 165 respectively in late March. They were 122 and 125 this morning. Considering I'm off Actos and only using half the metformin I once was using, this seems like real progress.
Like I said, the daily weight and fasting blood sugar levels fluctuate some and make trends hard to follow. I have "fixed" this by collecting the daily readings and paying attention but not worrying about them. What I "worry" about are the actual trends and these I can find by averaging every weeks data. For instance, my starting weight was 161.5 pounds and every week since the end of March I have lost between 1.5 and 3.4 pounds and have averaged a loss of 2.3 pounds per week. My goal was 2 pounds per week. The daily weight readings may fluctuate but the weekly average really does reveal what's going on.
In terms of weekly average blood sugar readings, a chart shows the trend more clearly. I seem to be dropping my fasting blood sugar readings by about 4 points per week. The most I have dropped in a week is 7 points and for the four weeks after stopping the Actos the trend went up a few points. I think the averages missed the peak of about 15 points. For the past three weeks I have been down 4, 4, and 3 points respectively. Exercise may have helped restore this trend. It is hard to say.
I am not rushing to stop taking metformin. Since I passed my Class 3 flight physical I don't need to be re-examined for another year (or close to it, actually) to keep flying. This gives me the flexibility to go off the metformin whenever I want to prior to my next physical. My first goal is my health and flying is a secondary (but important) goal. My estimated A1c based on both my monitoring and past tests is 6.0 to 6.5. These meet AACE recommendations and exceed ADA recommendations. My goal is to get it to 5.5 or less.
So what I am trying now is to keep the blood sugar coming down. If the 4 points per week decrease continues (on average) I should have a weekly average fasting blood sugar of under 100 in five weeks. At that point I should be another 10 pounds lighter, more or less and I may either quit metformin or cut it to 500 mg/d. I'm inclined to do the latter. It seems that the effect of metformin on blood sugar is related to how over-weight you are. The more over-weight the greater the effect. If this effect applies to me (each person is a rule unto themselves), then it's possible I will be able to quit the last 500 mg of metformin with little or no effect, if I wait until I'm under 200 pounds, which I am estimating will occur sometime in October.
Alternatively, if I see as little effect in reducing my daily dose from 500 mg 2 times per day to 1 time per day as I did with I decreased the dose form 1000 mg 2 times per day to 500 mg 2 time per day, which is to say there was no perceptible change, I may go off the metformin sooner.
My ultimate goal is to have my fasting blood sugars under 89 mg/dl consistently. That is roughly 28 more points to loose and to do it without taking any medicines. By my estimation I have dropped my blood sugar by between 80 and 100 mg/dl, if I had not reduced the drugs I was taking. I am not quite halfway to my weight goal and if the second half of my weight loss/improved nutrition and exercise program holds even one-third the promise of the first half of the program, I should be readily diet controlled, if not "cured" of my diabetes.
Time will tell.
So, before I get into the numbers, let me explain what numbers I track and how I track them...and maybe a bit about why I track them. The "how" piece is actually important, and I think a bit interesting - feel free to disagree.
Every morning when I get up (and the time does vary by a few hours some days) I check my fasting blood sugar and my weight. The fluctuate from day to day so trends are not always clear. I try to check my blood sugar before lunch and dinner and 2 hours after eating as well as before I go to bed. My blood sugar meter automatically calculates 14 and 30 day averages for all of the readings I collect. The fact is I have 3 meters and only one of them does the averaging. One meter is at work and the other is near where I eat.
My fasting blood sugar and three or four other readings are generally taken on the averaging meter. My methodology is not terribly consistent and therefore may not be scientifically reproducible but the trend line for both the 14 day and the 30 day readings has been steadily down. The 14 day and 30 day averages were 178 and 165 respectively in late March. They were 122 and 125 this morning. Considering I'm off Actos and only using half the metformin I once was using, this seems like real progress.
Like I said, the daily weight and fasting blood sugar levels fluctuate some and make trends hard to follow. I have "fixed" this by collecting the daily readings and paying attention but not worrying about them. What I "worry" about are the actual trends and these I can find by averaging every weeks data. For instance, my starting weight was 161.5 pounds and every week since the end of March I have lost between 1.5 and 3.4 pounds and have averaged a loss of 2.3 pounds per week. My goal was 2 pounds per week. The daily weight readings may fluctuate but the weekly average really does reveal what's going on.
In terms of weekly average blood sugar readings, a chart shows the trend more clearly. I seem to be dropping my fasting blood sugar readings by about 4 points per week. The most I have dropped in a week is 7 points and for the four weeks after stopping the Actos the trend went up a few points. I think the averages missed the peak of about 15 points. For the past three weeks I have been down 4, 4, and 3 points respectively. Exercise may have helped restore this trend. It is hard to say.
I am not rushing to stop taking metformin. Since I passed my Class 3 flight physical I don't need to be re-examined for another year (or close to it, actually) to keep flying. This gives me the flexibility to go off the metformin whenever I want to prior to my next physical. My first goal is my health and flying is a secondary (but important) goal. My estimated A1c based on both my monitoring and past tests is 6.0 to 6.5. These meet AACE recommendations and exceed ADA recommendations. My goal is to get it to 5.5 or less.
So what I am trying now is to keep the blood sugar coming down. If the 4 points per week decrease continues (on average) I should have a weekly average fasting blood sugar of under 100 in five weeks. At that point I should be another 10 pounds lighter, more or less and I may either quit metformin or cut it to 500 mg/d. I'm inclined to do the latter. It seems that the effect of metformin on blood sugar is related to how over-weight you are. The more over-weight the greater the effect. If this effect applies to me (each person is a rule unto themselves), then it's possible I will be able to quit the last 500 mg of metformin with little or no effect, if I wait until I'm under 200 pounds, which I am estimating will occur sometime in October.
Alternatively, if I see as little effect in reducing my daily dose from 500 mg 2 times per day to 1 time per day as I did with I decreased the dose form 1000 mg 2 times per day to 500 mg 2 time per day, which is to say there was no perceptible change, I may go off the metformin sooner.
My ultimate goal is to have my fasting blood sugars under 89 mg/dl consistently. That is roughly 28 more points to loose and to do it without taking any medicines. By my estimation I have dropped my blood sugar by between 80 and 100 mg/dl, if I had not reduced the drugs I was taking. I am not quite halfway to my weight goal and if the second half of my weight loss/improved nutrition and exercise program holds even one-third the promise of the first half of the program, I should be readily diet controlled, if not "cured" of my diabetes.
Time will tell.
Wednesday, July 6, 2011
More Progress
Last Thursday (6/30/11) I saw my family doctor for a routine diabetes check. On his scales I'd lost more than 35 pounds since March. I was off Actos, using a quarter of the blood pressure medicine I was in March and half the cholesterol medicine, and my total cholesterol was 125. All of my numbers looked good. He agreed I should cut back on metformin and suggested reducing my dosage from 1000 mg twice per day to 500 mg twice per day. We also discussed getting off medicines and fasting (a topic for a post of its own).
For the past 8 weeks my weekly average fasting blood sugar had been in the 120's for 6 of the 8 weeks. One week it was 115 and that was when I quit Actos and the following week it was 131. To me it seemed like I had stalled in my progress on dropping my blood sugar. I had been dropping 6 points per week and then nada. Last week I hit 120 and this week it looks like I'll beat that. So what's different besides I'm taking less medicine?
I "accidentally" discovered a couple of things. One discovery is exercising briefly (20 min) in the morning and again in the afternoon or evening has a noticeable affect on lowering blood sugar throughout the day. I can't be positive but it seemed like it also reduced the impact of starchy foods a bit.
The other discovery is mostly an answer to a question I had. What, if any, are the benefits of anaerobic exercise on blood sugar? It is well documented, and easy to measure personally, the beneficial effect of aerobic exercise on blood sugar levels. There's nothing like 30 minutes of walking or time on the Nordic Track to lower blood sugar after a meal. Gardening and yard work are more practical ways to experience both better blood sugar and a nicer yard. I have not found much on anaerobic exercise and it's effect on blood sugar.
Coincidentally a Bowflex came up for sale on Craigslist for $150 and I bought it. After two workouts, its a bit early to say much with certainty but my fasting blood sugar is clearly dropping. Not only that but this morning it was 101 mg/dl; 19 points better than it averaged last week. It could be a fluke reading. Or, it could be that anaerobic exercise is building muscle, perhaps less insulin resistant muscle, and the added muscle is burning a little more sugar overnight. This is the basis for the idea that exercise will raise your metabolism. For a diabetic, a higher metabolism means lower blood sugar if everything else stays the same.
One thing I'm not sure of if how long it takes the body to build new muscle and how energy intensive the process is. The lower blood sugar could be a result of the temporary responses to exercise and not new muscle mass. Either way, lower blood sugar is good and I'll keep working out on the Bowflex to see how far I can take this. A nearly 20 point reduction in blood sugar in just a few days is huge and holds a lot of promise.
My goal for my fasting blood sugar is to get it under 89 mg/dl. This goal now seems to be in reach. I have 40 or so pounds of fat to lose, the possibility of adding an unknown amount of muscle, and making other changes that will affect what genes are active and which ones are passive. Any one of these could take me to my goal. All of them together make the goal seem like it is not just achievable but also, not too far off.
For the past 8 weeks my weekly average fasting blood sugar had been in the 120's for 6 of the 8 weeks. One week it was 115 and that was when I quit Actos and the following week it was 131. To me it seemed like I had stalled in my progress on dropping my blood sugar. I had been dropping 6 points per week and then nada. Last week I hit 120 and this week it looks like I'll beat that. So what's different besides I'm taking less medicine?
I "accidentally" discovered a couple of things. One discovery is exercising briefly (20 min) in the morning and again in the afternoon or evening has a noticeable affect on lowering blood sugar throughout the day. I can't be positive but it seemed like it also reduced the impact of starchy foods a bit.
The other discovery is mostly an answer to a question I had. What, if any, are the benefits of anaerobic exercise on blood sugar? It is well documented, and easy to measure personally, the beneficial effect of aerobic exercise on blood sugar levels. There's nothing like 30 minutes of walking or time on the Nordic Track to lower blood sugar after a meal. Gardening and yard work are more practical ways to experience both better blood sugar and a nicer yard. I have not found much on anaerobic exercise and it's effect on blood sugar.
Coincidentally a Bowflex came up for sale on Craigslist for $150 and I bought it. After two workouts, its a bit early to say much with certainty but my fasting blood sugar is clearly dropping. Not only that but this morning it was 101 mg/dl; 19 points better than it averaged last week. It could be a fluke reading. Or, it could be that anaerobic exercise is building muscle, perhaps less insulin resistant muscle, and the added muscle is burning a little more sugar overnight. This is the basis for the idea that exercise will raise your metabolism. For a diabetic, a higher metabolism means lower blood sugar if everything else stays the same.
One thing I'm not sure of if how long it takes the body to build new muscle and how energy intensive the process is. The lower blood sugar could be a result of the temporary responses to exercise and not new muscle mass. Either way, lower blood sugar is good and I'll keep working out on the Bowflex to see how far I can take this. A nearly 20 point reduction in blood sugar in just a few days is huge and holds a lot of promise.
My goal for my fasting blood sugar is to get it under 89 mg/dl. This goal now seems to be in reach. I have 40 or so pounds of fat to lose, the possibility of adding an unknown amount of muscle, and making other changes that will affect what genes are active and which ones are passive. Any one of these could take me to my goal. All of them together make the goal seem like it is not just achievable but also, not too far off.
Saturday, June 18, 2011
Head scratching
It's been a month since I quit taking Actos. My fasting blood sugar rose about 20 points over about 2 weeks and then started back down. My weight loss accelerated for a while from about 2 lbs per week to 2.5 lbs per week (note: I weight myself every morning when I get up and average the whole week to get a "true" weight. Comparing weekly averages shows trends very well). This week I hit a minor milestone; I am now just fat, not obese. My BMI dropped below 30.
My weekly average fasting blood sugar this week is unchanged from last week. I started the week out moving down noticeably as the week moved on my fasting blood sugars have been steadily rising and there does not seem to be any apparent reason. They're now in the mid to high 130's. I've been sticking to my diet, consuming large quantities of fruits and veggies and small quantities of meat and fish and avoiding fats and sugars. I'm wondering if I have an infection somewhere that I can't feel...or can't feel yet. Hay fever maybe? I do have some congestion but not a lot.
For now I'll be patient and know that tomorrow starts a new week and hopefully a renewed downward trend in blood sugar and weight.
I've decided that its time to augment the diet with more exercise. The Nordic Track came upstairs, got dusted off and put to work for the first time in years. Six minutes was enough - could have gone longer but I was sweating and didn't want to over-due things. I will now be walking as before, riding my bike more, and using the Nordic Track. I just need to figure out a realistic goal. In my head I'd like to do an hour a day but I'm thinking 30 minutes, 6 times per week is more realistic. The correlation between exercise and lower blood sugar is clear but there I have not found a whole lot of qualitative information. What I have found seems unrealistic for me; 4 hours per day equals a 20% drop in blood sugar. That is a slightly bigger drop than what metformin typically does but I can't do 4 hours of exercise per day without giving up something I'm not willing to give up.
My weekly average fasting blood sugar this week is unchanged from last week. I started the week out moving down noticeably as the week moved on my fasting blood sugars have been steadily rising and there does not seem to be any apparent reason. They're now in the mid to high 130's. I've been sticking to my diet, consuming large quantities of fruits and veggies and small quantities of meat and fish and avoiding fats and sugars. I'm wondering if I have an infection somewhere that I can't feel...or can't feel yet. Hay fever maybe? I do have some congestion but not a lot.
For now I'll be patient and know that tomorrow starts a new week and hopefully a renewed downward trend in blood sugar and weight.
I've decided that its time to augment the diet with more exercise. The Nordic Track came upstairs, got dusted off and put to work for the first time in years. Six minutes was enough - could have gone longer but I was sweating and didn't want to over-due things. I will now be walking as before, riding my bike more, and using the Nordic Track. I just need to figure out a realistic goal. In my head I'd like to do an hour a day but I'm thinking 30 minutes, 6 times per week is more realistic. The correlation between exercise and lower blood sugar is clear but there I have not found a whole lot of qualitative information. What I have found seems unrealistic for me; 4 hours per day equals a 20% drop in blood sugar. That is a slightly bigger drop than what metformin typically does but I can't do 4 hours of exercise per day without giving up something I'm not willing to give up.
Tuesday, June 14, 2011
The progress continues
About one month ago I reduced my Actos and about 3 weeks ago I stopped it entirely. Initially the blood sugars rose about 20 points and last week started back down again. While the blood sugar went up a little, the weight just started to fall off - the doctor suggested taking Actos might make it difficult to lose weight. Well, stopping Actos makes losing it easier. In the past month I've lost 12 pounds, which beats my 2 pounds per week goal by about 50%.
The really interesting thing is I've started getting some "normal" blood sugar readings. I even had an 89 mg/dl reading 2 hours after eating dinner one evening. The improvement in readings suggests to me that there may be physiological changes happening. I might be becoming less insulin resistant, which is the goal of my process. I just wish I could figure out how to push the outcome more in the direction I want it to go. Maybe not necessarily faster but certainly more assuredly in that direction.
In two weeks I see my doctor again and I should have blood work done. I am hoping to see improvements in the lipid screen, blood pressure, and HbA1c and have a reduction in those medicines. Time will tell.
The really interesting thing is I've started getting some "normal" blood sugar readings. I even had an 89 mg/dl reading 2 hours after eating dinner one evening. The improvement in readings suggests to me that there may be physiological changes happening. I might be becoming less insulin resistant, which is the goal of my process. I just wish I could figure out how to push the outcome more in the direction I want it to go. Maybe not necessarily faster but certainly more assuredly in that direction.
In two weeks I see my doctor again and I should have blood work done. I am hoping to see improvements in the lipid screen, blood pressure, and HbA1c and have a reduction in those medicines. Time will tell.
Saturday, June 11, 2011
Evaluating progress and planning ahead
After 11 weeks of eating to get proper nutrition I have observed the following changes in my blood sugar.
1. My weekly average fasting blood sugar is approximately 40 points lower than when I started.
2. I have eliminated Actos from my treatment regime.
3. When I eliminated Actos (which wasn't done as cleanly as I'd like) I saw roughly a 20 point rise in blood sugar
4. Presumably if I was still on Actos my blood sugars would be 20 points lower still, representing a 60 point drop. I'll concede this is totally inferred and is not based on actual data.
5. It appears my new diet (what I'm eating, not how little I eat - the noun, not the verb) is resulting in an average 5-6 point drop in blood sugar per week.
6. I have lost 28 pounds and my blood pressure has dropped to 132/62 (nominally) and I've reduced my medicine by 75%.
7. The effect on lipid chemistry is entirely unknown but I'm guessing the report I'll get at the end of the month will be good. Again, no data, just my opinion.
Looking forward I've done some modest research on the effect of metformin on blood sugar. One study looked at patients taking 500 mg, 1000 mg, 1500 mg, and 2000 mg of metformin daily. It found the reduction in serum blood sugar varied from 19 mg/dl to 82mg/dl, respectively. It also found that there was a correlation between BMI and the effect of metformin. The reduction in blood sugar was noted in people who were over-weight (BMI 25 or more) and obese (BMI 30 or more). No effect was notice in people with a BMI <25 (i.e., normal weight).
So, I'll discuss my plan with my doctor but the concept is this. When my weekly average fasting blood sugar approaches 110 mg/dl I'll drop my metformin dosage by 500 mg. That should keep my blood sugars in a safe range. I'm currently taking 2,000 mg of metformin daily; 1,000 mg morning and again in the evening. I'll cut the evening dose first because the time to the next dose is short - frankly, I don't think it will matter. I expect I'll start reducing metformin in 3-4 weeks, assuming my blood sugars continue to drop. I also expect to be able to make additional cuts in metformin every 3-4 weeks.
Looking ahead, I think I will be off blood pressure medicine entirely in the next few months (maybe sooner). Unless my rate of change in fasting blood sugar averages changes (and it could speed up or slow down), I think I'll be off metformin (my last blood sugar drug) in September or October. One reason I am considering the possibility of the rate of change increasing, is I have read where fasting can cause biochemical changes in how glucose is produced and metabolized. It appears fasting for 2 days (or more) can improve insulin response significantly. A 2 day fast would be interesting both biologically and religiously, and I think that's worth pondering.
1. My weekly average fasting blood sugar is approximately 40 points lower than when I started.
2. I have eliminated Actos from my treatment regime.
3. When I eliminated Actos (which wasn't done as cleanly as I'd like) I saw roughly a 20 point rise in blood sugar
4. Presumably if I was still on Actos my blood sugars would be 20 points lower still, representing a 60 point drop. I'll concede this is totally inferred and is not based on actual data.
5. It appears my new diet (what I'm eating, not how little I eat - the noun, not the verb) is resulting in an average 5-6 point drop in blood sugar per week.
6. I have lost 28 pounds and my blood pressure has dropped to 132/62 (nominally) and I've reduced my medicine by 75%.
7. The effect on lipid chemistry is entirely unknown but I'm guessing the report I'll get at the end of the month will be good. Again, no data, just my opinion.
Looking forward I've done some modest research on the effect of metformin on blood sugar. One study looked at patients taking 500 mg, 1000 mg, 1500 mg, and 2000 mg of metformin daily. It found the reduction in serum blood sugar varied from 19 mg/dl to 82mg/dl, respectively. It also found that there was a correlation between BMI and the effect of metformin. The reduction in blood sugar was noted in people who were over-weight (BMI 25 or more) and obese (BMI 30 or more). No effect was notice in people with a BMI <25 (i.e., normal weight).
So, I'll discuss my plan with my doctor but the concept is this. When my weekly average fasting blood sugar approaches 110 mg/dl I'll drop my metformin dosage by 500 mg. That should keep my blood sugars in a safe range. I'm currently taking 2,000 mg of metformin daily; 1,000 mg morning and again in the evening. I'll cut the evening dose first because the time to the next dose is short - frankly, I don't think it will matter. I expect I'll start reducing metformin in 3-4 weeks, assuming my blood sugars continue to drop. I also expect to be able to make additional cuts in metformin every 3-4 weeks.
Looking ahead, I think I will be off blood pressure medicine entirely in the next few months (maybe sooner). Unless my rate of change in fasting blood sugar averages changes (and it could speed up or slow down), I think I'll be off metformin (my last blood sugar drug) in September or October. One reason I am considering the possibility of the rate of change increasing, is I have read where fasting can cause biochemical changes in how glucose is produced and metabolized. It appears fasting for 2 days (or more) can improve insulin response significantly. A 2 day fast would be interesting both biologically and religiously, and I think that's worth pondering.
Wednesday, June 8, 2011
Stuck
I'm off Actos and my blood sugar has stabilized around 135 (morning fasting average). It had been dropping about 6 points per week. When I went from 45 mg of Actos daily to 22.5 mg daily, it continued to drop. After stopping it altogether, it rose about 20 points from 115 to 135. I occasionally get a reading in the teens or twenties but mostly they are running in the mid thirties.
There are a bunch of possibilities as to what's going on. My diet remains about 1450 calories daily of mostly vegetable based foods. Exercise has slacked of a bit due to company and travel. I have been getting exercise but not as vigorous as before. So the lack of exercise is one possibility. Another possibility is my body is readjusting to not having any Actos after better than 10 years. If this is the case I would expect to see the readings start to drop in a week or so. A third possibility is this is as far as I can go with diet and exercise. I'm not ready to accept this yet.
On the positive side, I still have about 50 lbs to lose and that will reduce fat interfering with my body's insulin production and it will hopefully reduce insulin resistance too. The first question is whether this will be enough to get me "diet controlled" and the immediate next question is whether or not I can achieve more reversal of the disease.
My plan is to be patient, start using the Nordic Track indoors to avoid the heat, and keep on reading. T
There are a bunch of possibilities as to what's going on. My diet remains about 1450 calories daily of mostly vegetable based foods. Exercise has slacked of a bit due to company and travel. I have been getting exercise but not as vigorous as before. So the lack of exercise is one possibility. Another possibility is my body is readjusting to not having any Actos after better than 10 years. If this is the case I would expect to see the readings start to drop in a week or so. A third possibility is this is as far as I can go with diet and exercise. I'm not ready to accept this yet.
On the positive side, I still have about 50 lbs to lose and that will reduce fat interfering with my body's insulin production and it will hopefully reduce insulin resistance too. The first question is whether this will be enough to get me "diet controlled" and the immediate next question is whether or not I can achieve more reversal of the disease.
My plan is to be patient, start using the Nordic Track indoors to avoid the heat, and keep on reading. T
Wednesday, June 1, 2011
The Details of Type II Diabetes
Disclaimer - I am not a physician. I have an MS in Environmental Biology and oddly, that degree may be the perfect one to really understand Type II diabetes. Some might argue that if your only tool is a hammer, then every problem looks like a nail and therefore, my environmental approach to solving the riddle of diabetes starts using the wrong tool. I would suggest the data supports me and to some extent, puts physicians in the role or using the wrong tools (weight loss and drugs) to deal with diabetes. The best these tools can do is stave off the inevitable progression of the "disease." Changing the environment can at least halt the progress of the disease, and a growing body of evidence suggests it can reverse the disease. How far the reversal can go has not been quantified.
Type II diabetes is a group of "conditions" (diseases?) where the body develops resistance to insulin and blood sugar levels rise. The pancreas is still producing insulin; perhaps even more than a person without Type II diabetes. When insulin production increases, it appears there's a risk of "burning out" the beta cells in the pancreas that produce insulin. This is currently understood to be irreversible but this may soon be reversible thanks to modern medicine. So control of blood sugar is important to a Type II diabetic. When enough of the insulin producing cells die off, insulin injections become necessary. Interestingly the ADA (American Diabetes Association) has different and more lax standards than the AACE (American Association of Clinical Endocrinologists). More on this in another post.
In the book The China Study T. Colin Campbell shows a rather convincing graph comparing diets in six or seven different countries. The data are about 50 years old but aligned perfectly with his findings. Where a low fat-high carbohydrate diet is consumed diabetes is almost non-existant. Yes I said high carbohydrate. He then goes on to show a near perfect linear relationship showing the incidence of diabetes increases as the ratio of fat to carbohydrates increases. If the advice you've been getting is like what I've been hearing, you probably thought carbs were bad for diabetics. Some are for sure, like refined sugars and white flour, but they are not the cause of diabetes. They simply raise your blood sugar and stress your pancreas. Complex carbs, like those found in plants, are actually good for diabetics.
The causative factor of diabetes seems to be fat. Moreover, the body's environmental response to fat is to conserve the energy. Prior to meat becoming a common and primary element of the diet, the response made perfect sense and aided the survival of the animal. Fat was stored both in the cells and on the body (frequently around the waist or the buttocks). The body's response to fat also included reducing the number of mitochondria within the cells of the body. The mitochondria are found in essentially every living cell of the body and are where energy is produced. The process is known as the Krebs-citric acid cycle and reduces ATP to ADP releasing energy, and uses glucose to "recharge" the ADP to ATP.
The Krebs-Citric acid cycle is complicated but well known. What is important to know is intracellular fat is long-term stored energy for the body to use later - perhaps months or years later. ADP is what the body uses to produce energy and it is quickly recharged using glucose. Glucose is taken from the easiest source - foods that have recently been ingested. When this is exhausted the body uses glycogen, and finally fat, but not directly. This is why you can significantly drop your blood sugar by exercising after eating. You are using the glucose that your body absorbed from your meal. It is also why exercise "burns" fat.
The problem comes when a person eats too much fat. The body automatically wants to conserve the fat (this is not the "starvation mode" dieters experience) and predictably, it responds to excessive amounts of fat with an excessive response. Two different things happen, both of which contribute to Type II diabetes. First, in order to conserve energy the body reduces the number of mitochondria within the cells. With all the fat energy there you don't need all the mitochondria producing energy. Fewer mitochondria allow a person to function without burning off the fat needlessly. Fewer mitochondria also reduces the bodies ability to burn glucose quickly. The result is a small, perhaps insignificant rise in blood sugar. The other thing that happens is the intracellular fat interferes with the ability of insulin to communicate with the cell and allow it to bring glucose into the cell. I'd speculate that the cell is saying, "I'm full" take your glucose to a cell that's still "hungry." The body is placing a limit on how much intracellular fat it will allow.
If this explanation is accurate, and I can cite quite a body of hard science (as opposed to whack-a-do-docs selling a diet plan), then diabetes is an environmental disease. There is a small but growing body of supporting research to suggest that the environmental changes are the result of epigenetic changes. DNA markers change in response to environmental conditions causing the changes that have been described. The good news then is changing the environment, may be able to utterly reverse the disease. This would be the cure for diabetes. Interestingly, it isn't a pill or a shot but a change in the environment - mainly a change in one's diet that results in a cure. Isn't it ironic that the most modern medicine can do is prolong the progression of the disease while the individual has the power to cure themselves?
Next time - Working on a Cure.
Type II diabetes is a group of "conditions" (diseases?) where the body develops resistance to insulin and blood sugar levels rise. The pancreas is still producing insulin; perhaps even more than a person without Type II diabetes. When insulin production increases, it appears there's a risk of "burning out" the beta cells in the pancreas that produce insulin. This is currently understood to be irreversible but this may soon be reversible thanks to modern medicine. So control of blood sugar is important to a Type II diabetic. When enough of the insulin producing cells die off, insulin injections become necessary. Interestingly the ADA (American Diabetes Association) has different and more lax standards than the AACE (American Association of Clinical Endocrinologists). More on this in another post.
In the book The China Study T. Colin Campbell shows a rather convincing graph comparing diets in six or seven different countries. The data are about 50 years old but aligned perfectly with his findings. Where a low fat-high carbohydrate diet is consumed diabetes is almost non-existant. Yes I said high carbohydrate. He then goes on to show a near perfect linear relationship showing the incidence of diabetes increases as the ratio of fat to carbohydrates increases. If the advice you've been getting is like what I've been hearing, you probably thought carbs were bad for diabetics. Some are for sure, like refined sugars and white flour, but they are not the cause of diabetes. They simply raise your blood sugar and stress your pancreas. Complex carbs, like those found in plants, are actually good for diabetics.
The causative factor of diabetes seems to be fat. Moreover, the body's environmental response to fat is to conserve the energy. Prior to meat becoming a common and primary element of the diet, the response made perfect sense and aided the survival of the animal. Fat was stored both in the cells and on the body (frequently around the waist or the buttocks). The body's response to fat also included reducing the number of mitochondria within the cells of the body. The mitochondria are found in essentially every living cell of the body and are where energy is produced. The process is known as the Krebs-citric acid cycle and reduces ATP to ADP releasing energy, and uses glucose to "recharge" the ADP to ATP.
The Krebs-Citric acid cycle is complicated but well known. What is important to know is intracellular fat is long-term stored energy for the body to use later - perhaps months or years later. ADP is what the body uses to produce energy and it is quickly recharged using glucose. Glucose is taken from the easiest source - foods that have recently been ingested. When this is exhausted the body uses glycogen, and finally fat, but not directly. This is why you can significantly drop your blood sugar by exercising after eating. You are using the glucose that your body absorbed from your meal. It is also why exercise "burns" fat.
The problem comes when a person eats too much fat. The body automatically wants to conserve the fat (this is not the "starvation mode" dieters experience) and predictably, it responds to excessive amounts of fat with an excessive response. Two different things happen, both of which contribute to Type II diabetes. First, in order to conserve energy the body reduces the number of mitochondria within the cells. With all the fat energy there you don't need all the mitochondria producing energy. Fewer mitochondria allow a person to function without burning off the fat needlessly. Fewer mitochondria also reduces the bodies ability to burn glucose quickly. The result is a small, perhaps insignificant rise in blood sugar. The other thing that happens is the intracellular fat interferes with the ability of insulin to communicate with the cell and allow it to bring glucose into the cell. I'd speculate that the cell is saying, "I'm full" take your glucose to a cell that's still "hungry." The body is placing a limit on how much intracellular fat it will allow.
If this explanation is accurate, and I can cite quite a body of hard science (as opposed to whack-a-do-docs selling a diet plan), then diabetes is an environmental disease. There is a small but growing body of supporting research to suggest that the environmental changes are the result of epigenetic changes. DNA markers change in response to environmental conditions causing the changes that have been described. The good news then is changing the environment, may be able to utterly reverse the disease. This would be the cure for diabetes. Interestingly, it isn't a pill or a shot but a change in the environment - mainly a change in one's diet that results in a cure. Isn't it ironic that the most modern medicine can do is prolong the progression of the disease while the individual has the power to cure themselves?
Next time - Working on a Cure.
Monday, May 30, 2011
Progress
After changing my diet for about 6 1/2 weeks, my fasting blood sugar dropped 35 points and my doctor cut my Actos in half. Over the next 10 days my blood sugar continued to drop to about 50 points below where I started. My weekly average fasting blood sugar dropped from 166 to 115, so I dropped the Actos entirely. My fasting blood sugar raised about 15 points over the next two weeks and now appears to be dropping again. Concurrently, it appears that my blood pressure is dropping too.
After some reading (not really research) and a lot of thinking, I've discovered what I think is a problem with current medical advice. I've seen two general practitioners (my family doctor and an aeromedical doctor) and an endocrinologist. They all preach lose weight and your blood sugar will drop. There's some truth to the statement. While it isn't exactly false, it isn't exactly true either. Here's the truth (as I see it) - the problem is poor nutrition. Here's what I mean.
Poor nutrition means you eat all the calories you need in a mix of proteins, carbohydrates, and sugar but your not getting the vitamins, minerals, and phytonutrients that your body needs. So while the body gets enough calories, it has to make accommodations for the stress caused by the lack of nutrients. The result is high blood sugar, high blood pressure, high cholesterol, and excess weight.
My theory is nutrition controls weight, blood sugar, blood pressure, and cholesterol. If you get proper nutrition, all four metrics will drop and the results will start to show up quickly. In my case, after the first week of eating properly, my average fasting blood sugar had dropped 11 points and has continued to drop an average of 7 points per week. Compared to prescription medicines or weight loss, proper nutrition has made a bigger difference.
Now, what "proof" do I have that high blood sugar is a result of poor nutrition and not weight? Two reasons. First, about 8 years ago I lost about 50 pounds dieting and my blood sugar dropped no more than 20 points and I was taking 2,000 mg of metformin and 15 mg of Actos. The drop in blood sugar was nominal at best. My recent change in diet, aimed at getting proper nutrition, resulted in just a 20 pound weight loss (so far) but I've cut my Actos out and dropped my blood sugar by 50 points. I'm now getting occasional readings before meals that are under 100.
So what's next? I am attempting to find out if diabetes can be cured, not simply controlled. Control to me suggests there's no reversal or an incomplete reversal of insulin resistance. Under the best outcome a person can control their diabetes without medicine by simply controlling what they eat. A cure suggests that insulin resistance is reversed to the point where a person can pass an oral glucose tolerance test. Passing would mean a reading of less than 200, indicating the person was now "pre-diabetic." Ideally, the reading would be less than 140, indicating a normal response to the challenge.
In order to solve this problem, the first step is to understand the mechanics of Type II diabetes. The problem seems to be related to fat causing insulin resistance but the devil is in the details. Next time the details as I understand them.
Thursday, May 19, 2011
The Plan Develops
I question how well organized this blog is but in some ways it does follow a natural, if not logical, process. About two months ago my doctor urged me to "change my lifestyle" because I was gaining weight and loosing control of my blood sugar. He wanted me to change slowly, apparently over 5 or 6 years as I understood it. Lifestyle changes happen more or less instantly, as I've noted. So what is this lifestyle change I'm working on?
For starters, I may joke and kid but it isn't a diet and exercise plan. It is a plan for a different way of living. It started with a diet that shortly turned into a plan to eat healthy, nutrient dense foods and it included about 2 hours of exercise per week which has now risen to a goal of 3 hours per week.
Nutrient rich foods are mostly whole, raw fruits and vegetables. These provide protein, complex carbohydrates and a variety of vitamins, minerals, and other nutrients. I cut out most of my dairy consumption mainly because it is so high in calories and so low in nutrients. I still have a yogurt most mornings as part of my breakfast. I cut back (did not eliminate) meat. I rarely ate meat for breakfast and generally had 2 oz or less of ham for lunch. Now I may have ham 3 or 4 times per week for lunch (or turkey) and the rest of the time its mostly fruits and maybe beans and quinoa.
Dinners were the biggest change. For starters the wife and I have a huge salad - probably 4 to 6 cups worth of mixed dark green lettuces (not iceburg) and it will contain a variety of other vegetables and may have nuts and some feta on it. We'll eat just about any meat three days per week but will keep it to 4-6 ounces each. Twice per week we'll have fish or seafood and the other two days are vegetarian.
My total caloric intake is 1,600 or less and my average has been about 1,450 calories and to my shock, I'm not going around hungry. When I get hungry in the afternoon I'll have 1/4 cup of almonds and an orange. That's a 250 calorie snack the will keep me satisfied for about 2+ hours. The fact that I'm not hungry and the fact that when I achieve my ideal weight I should be able to have 500-650 more calories, suggests this really can become a lifestyle change. If I was always hungry, eventually I'd give in and eat again.
The results after 8 weeks are spectacular. My blood sugar (as measured by 30 over-all averages and by 7 day fasting averages) are down by over 50 points and I have reduced the medicines I'm taking. I'm getting ready to eliminate one of the blood sugar medicines all together. My blood pressure is as low as it has ever been as an adult (132/62) and I feel better; fewer achy joint and I have more energy. I'm looking forward to finding out what my cholesterol is.
My observations at this point are:
1. All three doctors I've seen in 11 years have preached weight loss over everything else. It seems to me they should be preaching nutrition over everything else. Inadequate nutrition is what causes diabetes, high blood pressure, obesity, and high cholesterol. None of these are diseases per se - they cause physical illness like heart attacks, strokes, kidney failure, and blindness but they are all simply symptoms of poor nutrition. The mantra should be "nutrition, nutrition, and nutrition" and everything else will take care of itself.
My proof of this is I am still obese (and will be until I lose 12-13 more pounds and then I'll be over-weight). However, I'm eating right, getting the nutrition I need and my blood pressure is dropping, my blood sugar is dropping, and my weight is dropping. My guess is my cholesterol is dropping but I don't have test results to prove it. So I'm still fat but with better nutrition I'm healthier. If I keep eating right, opting for good nutrition, I will also cease being fat.
2. Blood sugar levels respond faster to what you eat than to how much you weigh. The prime example of this is a friend of mine who was (is?) diabetic and weighed aver 350 lbs. He was on medication very similar to what I was taking. He had gastric bypass surgery. The next day he stopped taking diabetes medicines and radically changed his diet. He instantly was controlling his blood sugar with diet alone (and some modest exercise). His weight was not substantially different over night and the rubber band around his stomach didn't alter his insulin resistance. Nonetheless, his blood sugar readings went from marginally control one day to 130 or less the next day. The good news is he has lost more than 50 lbs, he is eating better (albeit small portions) and he is maintaining control of his blood sugars.
The two books my wife and I are loosely following are "Eat to Live" by Joel Fuhrmann and the China Study by Campbell and Campbell. Both eschew all animal fats and proteins. We're not convinced at this point that eliminating meat is essential. History shows (at least I believe it and anthropology show it), that man has eaten meat for tens of thousands of years. The key to understand is that man ate one hell of a lot less meat than we do now. It is doubtful that man ate meat more than once or twice per week when he was a hunter and gatherer. Only as civilization advanced did meat consumption increase. Even 300 years ago there's plenty of evidence that we didn't eat nearly as much meat as now....but we did eat meat.
The arguments these men make that the USDA and medical schools are overly influenced by meat and dairy lobbiests may be true. But that argument fails to explain what you should eat. Anthropology and history fill in a lot of holes in these data. Having said that, I'm much more kindly disposed toward most vegetarian and vegan mentalities.
For starters, I may joke and kid but it isn't a diet and exercise plan. It is a plan for a different way of living. It started with a diet that shortly turned into a plan to eat healthy, nutrient dense foods and it included about 2 hours of exercise per week which has now risen to a goal of 3 hours per week.
Nutrient rich foods are mostly whole, raw fruits and vegetables. These provide protein, complex carbohydrates and a variety of vitamins, minerals, and other nutrients. I cut out most of my dairy consumption mainly because it is so high in calories and so low in nutrients. I still have a yogurt most mornings as part of my breakfast. I cut back (did not eliminate) meat. I rarely ate meat for breakfast and generally had 2 oz or less of ham for lunch. Now I may have ham 3 or 4 times per week for lunch (or turkey) and the rest of the time its mostly fruits and maybe beans and quinoa.
Dinners were the biggest change. For starters the wife and I have a huge salad - probably 4 to 6 cups worth of mixed dark green lettuces (not iceburg) and it will contain a variety of other vegetables and may have nuts and some feta on it. We'll eat just about any meat three days per week but will keep it to 4-6 ounces each. Twice per week we'll have fish or seafood and the other two days are vegetarian.
My total caloric intake is 1,600 or less and my average has been about 1,450 calories and to my shock, I'm not going around hungry. When I get hungry in the afternoon I'll have 1/4 cup of almonds and an orange. That's a 250 calorie snack the will keep me satisfied for about 2+ hours. The fact that I'm not hungry and the fact that when I achieve my ideal weight I should be able to have 500-650 more calories, suggests this really can become a lifestyle change. If I was always hungry, eventually I'd give in and eat again.
The results after 8 weeks are spectacular. My blood sugar (as measured by 30 over-all averages and by 7 day fasting averages) are down by over 50 points and I have reduced the medicines I'm taking. I'm getting ready to eliminate one of the blood sugar medicines all together. My blood pressure is as low as it has ever been as an adult (132/62) and I feel better; fewer achy joint and I have more energy. I'm looking forward to finding out what my cholesterol is.
My observations at this point are:
1. All three doctors I've seen in 11 years have preached weight loss over everything else. It seems to me they should be preaching nutrition over everything else. Inadequate nutrition is what causes diabetes, high blood pressure, obesity, and high cholesterol. None of these are diseases per se - they cause physical illness like heart attacks, strokes, kidney failure, and blindness but they are all simply symptoms of poor nutrition. The mantra should be "nutrition, nutrition, and nutrition" and everything else will take care of itself.
My proof of this is I am still obese (and will be until I lose 12-13 more pounds and then I'll be over-weight). However, I'm eating right, getting the nutrition I need and my blood pressure is dropping, my blood sugar is dropping, and my weight is dropping. My guess is my cholesterol is dropping but I don't have test results to prove it. So I'm still fat but with better nutrition I'm healthier. If I keep eating right, opting for good nutrition, I will also cease being fat.
2. Blood sugar levels respond faster to what you eat than to how much you weigh. The prime example of this is a friend of mine who was (is?) diabetic and weighed aver 350 lbs. He was on medication very similar to what I was taking. He had gastric bypass surgery. The next day he stopped taking diabetes medicines and radically changed his diet. He instantly was controlling his blood sugar with diet alone (and some modest exercise). His weight was not substantially different over night and the rubber band around his stomach didn't alter his insulin resistance. Nonetheless, his blood sugar readings went from marginally control one day to 130 or less the next day. The good news is he has lost more than 50 lbs, he is eating better (albeit small portions) and he is maintaining control of his blood sugars.
The two books my wife and I are loosely following are "Eat to Live" by Joel Fuhrmann and the China Study by Campbell and Campbell. Both eschew all animal fats and proteins. We're not convinced at this point that eliminating meat is essential. History shows (at least I believe it and anthropology show it), that man has eaten meat for tens of thousands of years. The key to understand is that man ate one hell of a lot less meat than we do now. It is doubtful that man ate meat more than once or twice per week when he was a hunter and gatherer. Only as civilization advanced did meat consumption increase. Even 300 years ago there's plenty of evidence that we didn't eat nearly as much meat as now....but we did eat meat.
The arguments these men make that the USDA and medical schools are overly influenced by meat and dairy lobbiests may be true. But that argument fails to explain what you should eat. Anthropology and history fill in a lot of holes in these data. Having said that, I'm much more kindly disposed toward most vegetarian and vegan mentalities.
Monday, May 16, 2011
The Beginning of a Plan
Every 3 months I see my family physician for a routine diabetes check up. In the past I used an endocrinologist and the reasons for changing have more to do with personalities and our goofy "medical system" than it had to do with my wellness. The change has been problematic almost from the start - more on that later.
In late March of 2011 I went in for my routine check up. I was surprised to find I tipped the scales at 267. I was really expecting to come in at least 15 pounds lighter. My exam went fine but when my labs came back my HbA1c had climbed to 8.0. For the past 11 years they had run 7.2 to 7.4 and everyone had been pleased (not that they necessarily should have been. 6.5 is a better goal for a diabetic). The doctor wanted to start me on Byetta shots; a non-insulin control measure that would reduce my blood sugar and eliminate any chance I had for keeping my Class 3 FAA medical. My waiver called for oral medicines to control my diabetes. Reluctantly, the doctor remembered we had upped my Actos from 30 mg to 45 mg and he "allowed" me to go for 6 more weeks dieting and taking more medicine to see what happened.
I went back to reading about diabetes and figuring out a rational diet plan. My wife had been reading "Eat to Live" by Joel Furmann. MD and "The China Study" by Thomas Campbell II, PhD. Both books talked about hypertension, Type II diabetes, and cholesterol and how a vegan diet could reverse all three conditions. I like eating meat and I'm a biologist by training. I've got a pretty good idea why man has canine incisors. Unlike a lot of my colleagues, I read science with a critical eye. Furmann's book left me wondering if I was reading a book written by a dietary fanatic or someone who understood how important diet really was. His science left a lot to be desired - not flawed per se but full of unanswered questions. The China Study, which he relied on heavily, was far more convincing that animal fats AND animal protein caused or were closely linked to the cause of hypertension, high cholesterol, and Type II diabetes (in addition to a myriad of cancers and autoimmune diseases I didn't have or want).
My initial plan was simple. Lose 2 pounds per week - the most that seemingly could be done safely and do it by changing my lifestyle. My family doctor had been saying I needed to change my lifestyle but he kept looking for small changes. To me a lifestyle change is a big deal. Thirty-four years ago I quit smoking. I didn't cut back a little bit at a time. I simply became a non-smoker. It was 30 days of hell but I no longer even think about it. In reflecting on my life, every lifestyle change has been instantaneous - planned for success but instantaneous when it happens. One day I'm a smoker, the next day I'm not. One day I'm single, the next day I'm married. One day I'm not a parent, the next day I am. One day I was a fat 60 year old man and the next day I was a 185 pound 60 year man in an obese body that is becoming leaner.
When I made the lifestyle change I committed to eat healthy. That meant 1,700 calories or less, mostly fruits, vegetables and some meat and fish. I basically eliminated dairy, refined wheat (bread, cereal, and crackers) and alcohol from my diet. I also committed to at least 90 minutes of exercise per week. That was my initial plan. Here's the initial results.
Six weeks later I tipped his scales at 249 and my 30 day blood glucose averages were down over 30 points. I had kept a chart of my blood sugar (both 7 day averages of my morning fasting readings and my 30 day averages). These were compared to my weight loss. Let's just say I think that chart really made the doctors day. Here is what it showed (values for weight are shown on the left Y-axis and values for blood sugar are shown on the right Y-axis. Time is shown across the X-axis.
In late March of 2011 I went in for my routine check up. I was surprised to find I tipped the scales at 267. I was really expecting to come in at least 15 pounds lighter. My exam went fine but when my labs came back my HbA1c had climbed to 8.0. For the past 11 years they had run 7.2 to 7.4 and everyone had been pleased (not that they necessarily should have been. 6.5 is a better goal for a diabetic). The doctor wanted to start me on Byetta shots; a non-insulin control measure that would reduce my blood sugar and eliminate any chance I had for keeping my Class 3 FAA medical. My waiver called for oral medicines to control my diabetes. Reluctantly, the doctor remembered we had upped my Actos from 30 mg to 45 mg and he "allowed" me to go for 6 more weeks dieting and taking more medicine to see what happened.
I went back to reading about diabetes and figuring out a rational diet plan. My wife had been reading "Eat to Live" by Joel Furmann. MD and "The China Study" by Thomas Campbell II, PhD. Both books talked about hypertension, Type II diabetes, and cholesterol and how a vegan diet could reverse all three conditions. I like eating meat and I'm a biologist by training. I've got a pretty good idea why man has canine incisors. Unlike a lot of my colleagues, I read science with a critical eye. Furmann's book left me wondering if I was reading a book written by a dietary fanatic or someone who understood how important diet really was. His science left a lot to be desired - not flawed per se but full of unanswered questions. The China Study, which he relied on heavily, was far more convincing that animal fats AND animal protein caused or were closely linked to the cause of hypertension, high cholesterol, and Type II diabetes (in addition to a myriad of cancers and autoimmune diseases I didn't have or want).
My initial plan was simple. Lose 2 pounds per week - the most that seemingly could be done safely and do it by changing my lifestyle. My family doctor had been saying I needed to change my lifestyle but he kept looking for small changes. To me a lifestyle change is a big deal. Thirty-four years ago I quit smoking. I didn't cut back a little bit at a time. I simply became a non-smoker. It was 30 days of hell but I no longer even think about it. In reflecting on my life, every lifestyle change has been instantaneous - planned for success but instantaneous when it happens. One day I'm a smoker, the next day I'm not. One day I'm single, the next day I'm married. One day I'm not a parent, the next day I am. One day I was a fat 60 year old man and the next day I was a 185 pound 60 year man in an obese body that is becoming leaner.
When I made the lifestyle change I committed to eat healthy. That meant 1,700 calories or less, mostly fruits, vegetables and some meat and fish. I basically eliminated dairy, refined wheat (bread, cereal, and crackers) and alcohol from my diet. I also committed to at least 90 minutes of exercise per week. That was my initial plan. Here's the initial results.
Six weeks later I tipped his scales at 249 and my 30 day blood glucose averages were down over 30 points. I had kept a chart of my blood sugar (both 7 day averages of my morning fasting readings and my 30 day averages). These were compared to my weight loss. Let's just say I think that chart really made the doctors day. Here is what it showed (values for weight are shown on the left Y-axis and values for blood sugar are shown on the right Y-axis. Time is shown across the X-axis.
It may be hard to read but based on my weekly averages for weight, fasting blood sugars and my running 30 day averages (calculated by my glucometer) it shows my weight dropped from 258 (the average of the first week of daily readings) to 246 and my 30 day average glucose readings went from 174 to 141 and my fasting weekly average glucose readings dropped from 164 to 130. In short, I was making remarkable progress. My blood pressure at that visit was 132/62. I don't remember ever getting a bottem number in the 60s - ever. The doctor cut my blood pressure medicine in half and my Actos in half. A week later my blood sugar is continuing to drop and my weight continues to fall; albeit slowly.
I've revised the plan slightly since starting. I've decided to increase my exercise to two hours per week (and I'd like to do more) and based on observing my blood sugar results, my wife and I are going to eat meatless meals twice per week, fish or seafood twice per week, and meat three times per week. I monitor my blood sugar a lot. I want to know how food affects my sugar levels. I've learned a lot doing this and I avoid problem foods.
My weight goal is 185 pounds and I think I will be completely off blood sugar medicines well before I reach my goal. Looking at a trend analysis, I think I will no longer need Actos with the next four weeks. Some where between 220 pounds and 200 pounds I will either have seriously reduced or no longer need to take Metformin. But only time will tell for certain.
The real question I have is can diabetes (i.e., insulin resistance) be reversed. Both Furmann and Campbell say it can be reversed. That's pretty strong language. Neither of them give sufficient evidence to support that claim, in my opinion. Campbell provides a plausible theory and both Campbell and Furmann provides dietary instructions to try to implement the theory. The American Diabetes Association says diabetes has no cure. Who is right and how would you know?
If diabetes can be cured with a change in diet, I am well positioned to test the theory. My blood sugar has dropped almost 40 points now in response to diet and exercise. Perhaps more if you allow for taking less medication. If this represents lower insulin resistance, then I am working on my own cure. If this represents me living within the limits of my body's irreversible insulin resistance then I am on my way to being a diet controlled diabetic. Either way my Class 3 medical will be easier to get, I will be likely to live longer and have a higher quality of life.
But...how will I ever know whether I'm cured or simply living within my fixed insulin resistant limits? That's an easy question. If I am cured I will be able to pass an oral glucose tolerance test (OGTT) that defines whether you are healthy, pre-diabetic, or diabetic. At some point, perhaps a year or more after gaining control of my diabetes without medicine, I'll take an OGTT and see where I fit on the scale.
What do I think will happen? I am a scientist; I don't know. There are no data that I have seen that support the position that I can be cured. However, there's a plausible theory for the mechanism and some anecdotal data to suggest it is possible. Either way (cured or not) I will be doing the most I can to be healthy. I don't see how I can lose and I will learn something valuable to me, first hand.
My latest HbA1c results came back this afternoon. The doctor was reluctant to test after just seven weeks but he did do the test. It was 7.0 - down from 8.0 just seven weeks earlier. For those who are interested in home testing, I ran a home HbA1c test the same day they drew blood. My result was 7.5, not bad but I had hoped for a closer association. I'm not sure how accurate the lab test is so its hard to say much other than they're close.
The test strips that diabetics use to measure serum glucose are +/- 20% (I asked the folks at One Touch after some odd readings between meters). At a $1 per strip I would expect a lot better than 20% but then again, we're talking about a broken medical system. My sense is no one in the industry wants a cure. Certainly not the pharmaceutical companies that sell me drugs to take daily, not the insurance companies who get a cut of the action and can justify higher rates as more people get chronically ill, and certainly not the folks that make test strips and other diabetes supplies.
Saturday, May 14, 2011
Starting off Misinformed
Pilots over 40 years of age are required to have a medical exam every 2 years to maintain a 3rd class certification. These are your recreational pilots. My diabetes was discovered during a routine aeromedical exam. I'm guessing these sorts of discoveries are rare because, during that visit, every doctor and nurse in the office made a point of walking by my examination room and staring at me like I was some kind of exhibit. I told myself it was just coincidence. Then I overheard my physicians nurse telling other nurses about me and the receptionist, when I made a follow up visit, a person who should have known nothing, asked me if I was surprised to find out I diabetes. So much for HIPAA, patient privacy, and human dignity.
My initial HbA1c was 13 as I recall and my blood serum glucose levels were just over 300. Two years earlier I had tested normal during a routine aeromedical exam. The doctor reassured me it was not my fault and it was entirely genetic and it was just my turn to become diabetic. He was misinformed. It was my diet, not my genes, that caused my diabetes. He prescribed two medicines and 60 days later my HbA1c was well under 9, he was satisfied with my control and he issued my medical. It was not until a few years later, when I switched doctors, that I learned I needed a waiver for that medical to be legal.
The best medical advice I've received over the past 11 years is some people can control their diabetes without medicine, if they lose enough weight. That is consistent with the advice I received from an endocrinologist I eventually began seeing. The emphasis is on carbohydrate management. When you pay money to get professional advice there's a tendency to believe what you hear. After all, the professionals are supposed to be looking out for you. Unfortunately, the world is more complicated than this. Every bit of medical advice I got was rooted in fact but failed to communicate the truth about what causes diabetes and how to best treat it. It is not genetics, it is diet that causes diabetes. It is not carbohydrates that cause the illness, it is animal fat and animal protein.
I am not suggesting there is any malice or malpractice but the medical industry is broken. Moreover, there is an odd human trait that makes long-held beliefs hard to change. Data shows genetics plays a very small, almost insignificant role, in determining the onset of diabetes. The problem is diet. Moreover, while some carbohydrates cause blood sugar to rise when they're consumed, the problem Type II diabetics have is related to insulin resistance. The body is generally believed to be making adequate insulin (maybe even in excess) but the insulin cannot work effectively because of insulin resistance.
It seems that certain types of fats cause cells to become insulin resistant. The glucose which exists in blood serum can no longer get into cells because the insulin is ineffective at transporting the glucose across the cell walls. The question then is, can this resistance be reversed? It seems the scientific jury is still out on the answer to this. Certainly there's no shortage of crackpots saying yes. I do not consider their opinion. There are also some highly educated, well-published scientists and physicians who are starting to argue it can be reversed. The majority opinion is that it cannot be reversed, only halted in its tracks.
As a scientist, I look for data. So far I have seen no hard data that convinces me diabetes can be reversed with any certainty. I am however, inclined to think the same data that convincingly show the dietary causes of the disease also suggest the potential for reversal. With hope for a reversal, I am now seven weeks into a dietary changed aimed at reversing my diabetes.
Friday, May 13, 2011
Diabetes and the FAA
Type II diabetes does not have to be the end of a non-commercial pilot's flying career. It is however a royal pain in the ass to deal with, and I speak from experience. There's no sense in arguing with the FAA about how type II diabetes is a non-issue for recreational pilots, they don't listen to arguments, they follow their regulations. Rather than beat your head against a wall that you will no move, I suggest you read the rules carefully. You too can play by the rules and keep your medical active; I've been doing it for more than 10 years.
First, you need to show 60 days of control, at which time the FAA will issue a written waiver (and a medical) and as long as the waiver is good, your local AMA can issue you future medicals. You'll need to find a doctor to treat your diabetes and an ophthalmologist to examine your eyes and both must certify that you're in good health according to the waiver.
If you are smart though, this will just be the start for you. I wasn't smart but I'm getting smarter and my life with the FAA should get easier. Getting smart means curing your diabetes. Considering my past dealings with the FAA, I doubt that they are going to believe in a cure, but they do believe that you can control diabetes without medicines using a combination of diet and exercise.
I don't know if I can cure my diabetes yet but in a few months (or sooner) I should know. I do know this, I've figured out how to control my blood sugar using diet and exercise with less and less medicine. I've found credible evidence the damage is reversible (but not proof) and I have data on my body's response to dietary changes that shows a reversal. The question that remains is how far can I push the reversal? I see four possibilities: fewer oral medicines, no medicines, no medicines and only an impaired glucose tolerance, and cured - meaning I can pass a oral glucose tolerance test.
More on the diet (and exercise) in future blogs.
First, you need to show 60 days of control, at which time the FAA will issue a written waiver (and a medical) and as long as the waiver is good, your local AMA can issue you future medicals. You'll need to find a doctor to treat your diabetes and an ophthalmologist to examine your eyes and both must certify that you're in good health according to the waiver.
If you are smart though, this will just be the start for you. I wasn't smart but I'm getting smarter and my life with the FAA should get easier. Getting smart means curing your diabetes. Considering my past dealings with the FAA, I doubt that they are going to believe in a cure, but they do believe that you can control diabetes without medicines using a combination of diet and exercise.
I don't know if I can cure my diabetes yet but in a few months (or sooner) I should know. I do know this, I've figured out how to control my blood sugar using diet and exercise with less and less medicine. I've found credible evidence the damage is reversible (but not proof) and I have data on my body's response to dietary changes that shows a reversal. The question that remains is how far can I push the reversal? I see four possibilities: fewer oral medicines, no medicines, no medicines and only an impaired glucose tolerance, and cured - meaning I can pass a oral glucose tolerance test.
More on the diet (and exercise) in future blogs.
Subscribe to:
Posts (Atom)