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.

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.

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.

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.  

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.

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.