What Do I Know Now That I Didn’t Know Then? — part 1

With the exception of yesterday’s post, I’ve neglected my blog for over a year now, thinking I had resolved all the controversies that applied to my situation, at least to my own satisfaction. Ah, me of great arrogance and little humility … little did I know.

So, what do I know now that I didn’t know then? I’ll put up a preliminary list here, just off the top of my head, and perhaps add to it later:

  • When my thyroid hormones are at the proper level and I’m eating a mostly whole food, unprocessed, plant-based diet along with the recommended amount of exercise, it is actually easier to lose a few pounds than it is to gain them back.
  • My high fat, high protein diet may have graduated me from pre-diabetic to full-fledged. … Or not.
  • Beans, beans, the magical fruit!
  • The order in which I eat the individual items in a meal can greatly affect the magnitude of my postprandial (PP) blood glucose (BG) spike.
  • Whether the effect of high or low protein in your diet is beneficial or detrimental seems to be age dependent.
  • I’ve been a huge believer in letting PRAL be my food balancing guide, but according to Dr Greger, “The decades-old dogma that the acid-forming quality of animal protein leads to bone loss has been called into question.”
  • The placebo effect can be enormous and is nothing to be trifled with.
  • I have a tendency (perhaps shared with most of humanity) to leap to conclusions before they have been fully justified.

I don’t want to get into all of these exhaustively right now, but I do want to say at least a little.

Thyroid Hormones

If you’re around my age and still having trouble with that ever increasing poundage, the problem may be with your thyroid. According to the NIH Medline:

Men often gain weight until about age 55, and then begin to lose weight later in life. … Women usually gain weight until age 65, and then begin to lose weight. 

If you’re over 65, the chances your thyroid isn’t doing it’s job is 1 in 10, increasing with age. And even if you’re younger, if you are having trouble keeping the weight from piling up, there’s still a substantial chance of hypothyroidism, especially if you are female and/or have other symptoms of low thyroid. It’s a cheap test; ‘nuf said.

That said, I have come to realize that although I thought I knew something about weight loss, everything I’ve done in the last 5 years is confounded by the fact that I got older and there is a natural downturn in weight around this age. Did my low carb diet help me lose weight or did my age help me lose weight? Will losing that weight even be beneficial to me in the long term? I don’t think anyone can answer those questions.

High Fat Diets and Diabetes

This is a huge topic, so I just want to touch on it right now. I first became aware that the low carb version of Paleo might have adverse consequences on glucose metabolism thanks to Evelyn aka CarbSane. Evelyn’s posted on numerous occasions about the connection between high fat diets, elevated postprandial free fatty acids and pancreatic islet damage. Here’s one of them.

I resisted following up on it because I thought I had all the answers. Then at the beginning of this year, I had an extended email discussion about this with a fellow Yahoo group member who is a nutritionist and a consultant for the Mcdougall Program. He now eats a plant-based high carb and has sterling blood glucose control, although years ago did have blood sugar problems on the SAD. This email exchange with the nutritionist came after a previous lengthy email exchange with fellow blogger, Maria Mae Stevens, where she was hinting (well, maybe stronger than that) that my high fat diet might not be benign.

The nutritionist suggested I have my fasting insulin tested in order to determine whether I was insulin resistant or insulin insufficient, and so I did. My fasting glucose was reported at 82 mg/dL — this was very good — with no detectable insulin to the limits of the test sensitivity ( < 2.0 uIU/mL) — this not so good. Insulin resistance is usually diagnosed at fasting insulin > 8.6 uIU/mL. The online HOMA calculator I found estimated my insulin sensitivity at 4 times more sensitive than the average. So in other words, I wasn’t showing up  as insulin resistant. So, I decided to do a home oral glucose tolerance test (OGTT) to see just how bad things were. Here’s my results:

Jan 19 OGTT

In case you are not familiar with the OGTT, it is a brutal test for anyone with glucose disposal problems. You down 75 grams of glucose in a 10 minute interval and then watch your blood sugar levels go crazy. After 2 hours, my blood glucose, already high enough for a diabetes diagnosis, was seemingly still rising. The test being officially over, I went for a walk with my glucometer. It took a full hour of walking to get my BG back to normal levels and about a week for my PP BG numbers to return to what they were pre-test. It was during this week that I started using exercise after meals (especially breakfast) to keep my BG numbers down.

I felt like I had a problem that needed to be dealt with. Although it wasn’t clear that a strategy to reduce insulin resistance, ie lowering my fat intake, would have any positive effect in my case, I decided it was time for another diet experiment. I’d had some lab work done at the end of Feb that reported an A1c of 5.2, so I felt confident that even if my insulin was completely inadequate, I could keep my BG in check with exercise and give my β-cells a chance to come back a little. It didn’t seem like I could make matters worse and the upside potential was more dietary freedom, better glucose control and less worry about continued long term β-cell impairment.

Just to be clear, I am NOT saying that my high fat diet trashed my β-cells. A certain percentage of pre-diabetics graduate to the full monte all the time; I don’t think it’s been established who will progress and why. Perhaps my low carb diet was even beneficial and possibly delayed the inevitable. We just don’t know. Regardless, the diet experiment was to replace 20% of my caloric intake that was formerly fat with carbs, use exercise to prevent horrendous PP glucose spikes and after my glucose metabolism was hopefully upregulated, recheck my lipid panel and A1c.

Long story short, the diet was a dismal failure. The good news was, I re-discovered my long lost ability to exercise at my aerobic threshold for 25 min and after I recovered from the experiment, I found my legs to be hella stronger. The bad news was that with all that exercise and only being able to consume a limited amount of carbs at each meal without overwhelming my glucose disposal strategy, I was in an energy deficit situation. My weight plummeted and I couldn’t sleep through the night. My doctor advised that I go back to low carb, and so I terminated the diet experiment on April 1, after only 22 days. In the chart below, you can see my weight dropping from 114 to 111 in 3 weeks (the vertical cyan lines are only slightly relevant – they are days that I did resistance training).

3 Week Diet Experiment, Mar 10 – Mar 31

Before contacting my doctor, I had done a second home OGTT to see if there had been any improvement. To my utter dismay, it seemed to be quite the opposite. Here’s the March 28 OGTT (in red) vs the previous January 19 (in blue):

Home OGTT towards the end of the diet experiment

Home OGTT towards the end of the diet experiment in red

Now, just looking at the chart, one might infer that there had been a huge improvement. Sadly, not so! There was an immediate, obviously unopposed, glucose spike that so totally freaked me out that I decided to abandon the test and instead of sitting quietly for the OGTT as you are supposed to do, I grabbed my glucometer and started up a 400 foot elevation climb just outside of my house as fast as I could go. It took almost a half hour at my anaerobic threshold to bring my BG back down below 140, so I patted myself on the back and sat down to rest … only to see my BG bounce back up again 20 minutes later. I repeated the whole sequence, including observing a second BG bounce until finally it was down and stayed down.

Now maybe somebody out there knows more about this stuff than I do and can set me straight, but to me, this March OGTT was showing that whatever minuscule β-cell function I had, it was totally overwhelmed by 75g of glucose. Not only that, my β-cells were less functional than they had been 2 months prior.

So, yes, I abandoned my diet experiment and if that was the total end of the story, I wouldn’t have written so much about this. Along with returning to my higher fat diet, I also hit pubmed to see what I could learn about my situation. So bear with me here; there is a light at the end of this tunnel and there is stuff I’ve learned that may be helpful to others.

Continue to part 2 here: What Is the Best Diet for Managing Diabetes?

About Dan Hunter

Retired software engineer wading through the obfuscation, confusion and contradiction that corporate and political funding of medical research along with ego over science has created.
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