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.
Very proud of you, husband!
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