Daily Status – 2016-08-27

Things are going really well on LCHF+IF. Here’s my Insulin use.

Here is my Blood Glucose levels:

My Blood Glucose level continues to fall since getting off Insulin completely. It is averaging around 100 every day which seems like a decent number for where I am at (just 4 weeks in).

I am eating LCHF and doing IF. I didn’t weigh myself at the start, but I am down more than 20 lbs now.

Decide today I would cut my Metformin to 1x with my dinner meal. Eliminated my statin earlier this week as well as my Niacin tablet.

Our Diabetic Meds May Be Making Us Sicker

A study by Mayo Clinic doctors on Blood Glucose control (Cardiovascular Quality and Outcomes. 2016;116.002901. Glycemic Control for Patients With Type 2 Diabetes Mellitus: Our Evolving Faith in the Face of Evidence René Rodríguez-GutiérrezVictor M. Montori). The study:

We sought to determine the concordance between the accumulating evidence about the impact of tight versus less tight glycemic control in patients with type 2 diabetes mellitus since the publication of UKPDS (UK Prospective Diabetes Study) in 1998 until 2015 with the views about that evidence published in journal articles and practice guidelines.

They noted the fact that:

There is also no significant effect [of tight control of glucose] on all-cause mortality, cardiovascular mortality, or stroke; however, there is a consistent 15% relative-risk reduction of nonfatal myocardial infarction.

They concluded:

Discordance exists between the research evidence and academic and clinical policy statements about the value of tight glycemic control to reduce micro- and macrovascular complications. This discordance may distort priorities in the research and practice agendas designed to improve the lives of patients with type 2 diabetes mellitus.

Status 2016-08-25

Took a blood sugar measurement before dinner last night and measured 80. Wow. Spent most of the day earlier around 100 (a few points above and below). My body is really expecting dinner and is pumping its own insulin in preparation. I may have to shake things up and try skipping dinner one day for a 40+ hour fast – just to confuse my body. If I do it, I will be careful to measure frequently to avoid going too low. LOL. Hard to imagine such a thing “naturally”.

Weight took a unexpected bounce up this morning. I had 5 pcs of bacon and 4 eggs for dinner last night with a lot of cheese.

Cooked the eggs in all the bacon fat. My guess is the weight pop was due to the salt in the bacon and the rest of the meal. It’s the really cheap bacon from Sam’s Club. The cheapest out there. I need to upgrade my food sources but it’s tough living in the boonies. Maybe a trip to the big city is in order.

No beer again last night.

Blood sugar when I got out of bed was around 104. Incredible number for me since I’ve never seen numbers like that while I was on Insulin shots. Just measured in the middle of the day and it was 101. My seven day average is at 111. Down from 125 last week and down from 159 last month when I was on Insulin.

Disappointing news on the Blood Glucose meter front. I had switched to the Bayer Contour Next that came with my Insulin pump last year. I liked it since the numbers were higher on that meter than on my OneTouch Ultra meters (they measure close to each other). I also like that it looks like a USB stick and has a USB jack at the one end. Their charting software makes decent graphs.

Problem is my insurance company only allows OneTouch. There’s a USB cable for the OneTouch UltraMini that costs $29.99. If I’m hitting numbers in the 110s and lower I really don’t need to download my numbers. So I guess I am stuck with the OneTouch UltraLink and OneTouch UltraMini meters. Only reason I really need a cable is to make graphs to upload to this BLOG.

The dumb part is that although there is software for the OneTouch meters, the version I have only works in conjunction with the Insulin Pump. The meter sends the value to the pump and the pump can be uploaded to the software. No pump? No uploading.

Apple Cider Vinegar

Real. Vinegar helps with Blood Sugar levels (Diabetes Care 2004 Jan; 27(1): 281-282. Vinegar Improves Insulin Sensitivity to a High-Carbohydrate Meal in Subjects With Insulin Resistance or Type 2 Diabetes. Carol S. Johnston, PHD, Cindy M. Kim, MS and Amanda J. Buller, MS).

These data indicate that vinegar can significantly improve postprandial insulin sensitivity in insulin-resistant subjects.

The type of Vinegar used was Apple Cider Vinegar. The upper curve is the control. The lower slide is on Apple Cider Vinegar.

Tried it

I tried Apple Cider Vinegar last night for the first time. Found it at my local grocery store (the nicer one, not Walmart). Also found Coconut Oil. Ate a scoop of that – interesting taste. (Added: Article on ACV).

First I tried the Apple Cider Vinegar from a tablespoon. That was rough for my first time. Then I poured a few tablespoons into a glass and drank it. Not sure that’s the best way but I actually liked the taste a bit. It is acidic (at least to the mouth and throat) but my guess is that it’s not more acidic than the stomach. Can’t say objectively that it did help my blood sugar (see below)

Coconut Oil didn’t taste as good as salted butter does. It had a weird consistency. Now that I know what it tastes like I am going to have to figure out how to consume it.

Dinner last night was eclectic. Tablespoon of Coconut oil. A pile of green olives. A cup of Macadamia Nuts. Made a bunch of Pico de Gallo and ate a couple of bowls of that. Figure about 1000 calories from the nuts (with about 95% calories from fat). Maybe 100 calories from the olives. At least a few hundred calories from the Pico de Gallo. The nuts are high in fiber so that counteracts some of the carbs (not too high anyway). The Pico de Gallo had some carbs, but not too much. And it was all veggies which I need.

I did Intermittent Fasting all day yesterday. The five lbs I had put on the day before (I attribute it to salty bacon) was all gone by the middle of the day – plus another lb. Today I was down another couple. Certainly more than 20 lbs down from a month ago.

Best news was this morning I slept in (my day off) and my Blood Sugar was 91. I have never seen a number like that when I was pumping Insulin.

Father of Insulin Resistance – Gerald Reaven

Dr Gerald Reaven of Stanford Medicine, may be my new hero. Dr Reaven:

Jerry is credited with developing the insulin suppression test, the first quantitative method to measure insulin-mediated glucose uptake in humans. Using this technique, he established the importance of insulin resistance in human disease, and importantly, in type 2 diabetes.

[Added 2017-11-30]: Dr Reaven delivered the seminal paper on the subject of Insulin Resistance at the Banting Lecture in 1988 (Role of Insulin Resistance in Human Disease).

And –

Dr. Reaven challenged the then prevailing theory that defective insulin secretion adequately explained the hyperglycemia of T2DM, postulating that insulin resistance might be as, or more, important.

He is a prolific writer of studies. Here’s just one (All obese individuals are not created equal: insulin resistance is the major determinant of cardiovascular disease in overweight/obese individuals) of his papers.

[Added 2017-11-30]: Another hero is Dr Kraft.

Related to the Kraft Test (Kristine Faerch, Adam Hulman, Thomas P.J. Solomon. Heterogeneity of Pre-diabetes and Type 2 Diabetes: Implications for Prediction, Prevention and Treatment Responsiveness. Current Diabetes Reviews, Volume 12 , Issue 1 , 2016).

We aimed to examine heterogeneity in glucose response curves during an oral glucose tolerance test with multiple measurements and to compare cardiometabolic risk profiles between identified glucose response curve groups. We analyzed data from 1,267 individuals without diabetes from five studies in Denmark, the Netherlands and the USA. Each study included between 5 and 11 measurements at different time points during a 2-h oral glucose tolerance test, resulting in 9,602 plasma glucose measurements. Latent class trajectories with a cubic specification for time were fitted to identify different patterns of plasma glucose change during the oral glucose tolerance test. Cardiometabolic risk factor profiles were compared between the identified groups. Using latent class trajectory analysis, five glucose response curves were identified. Despite similar fasting and 2-h values, glucose peaks and peak times varied greatly between groups, ranging from 7–12 mmol/L, and 35–70 min. The group with the lowest and earliest plasma glucose peak had the lowest estimated cardiovascular risk, while the group with the most delayed plasma glucose peak and the highest 2-h value had the highest estimated risk. One group, with normal fasting and 2-h values, exhibited an unusual profile, with the highest glucose peak and the highest proportion of smokers and men. The heterogeneity in glucose response curves and the distinct cardiometabolic risk profiles may reflect different underlying physiologies. Our results warrant more detailed studies to identify the source of the heterogeneity across the different phenotypes and whether these differences play a role in the development of type 2 diabetes and cardiovascular disease.

An Association Study Against LCHF

There is one study that looks bad for LCHF. It looks bad mostly based on the name of the study rather than the science (American Journal of Epidemiology, Volume 134, Issue 6, 15 September 1991, Pages 590–603. High-Fat, Low-Carbohydrate Diet and the Etiology of Non-Insulin-dependent Diabetes Mellitus: The San Luis Valley Diabetes Study. Julie A. Marshall Richard F. Hamman Judith Baxter).

The study (1990) suggests that High Fat diets are associated with onset of non-insulin dependent diabetes mellitus.

The findings support the hypothesis that high-fat, low-carbohydrate diets are associated with the onset of non-insulin-dependent diabetes mellitus in humans.

The problem is that, at least in the abstract, there’s no evidence that the people were on anything at all related to a Low Carbohydrate diet. That was inferred based on the High Fat. But you don’t need to go any farther than your local McD’s to know that french fries are both high in fat and high in carbs.

When you look close you can see that the study was an association study not a Randomized Control Trial. Association does not prove causation. Just because people who got diabetes at lower carb/higher fat diets doesn’t mean that the diet caused the diabetes.

This paper (Risk Factors for Non-Insulin Dependent Diabetes. Marian Rewers, MD, PhD, and Richard F. Hamman, MD, DrPH) lists quite a few studies on this subject (Table 9.6) and includes a helpful comment:

There are substantial methodological problems in measuring exposure to behavioral factors such as physical inactivity and diet pp 179-181. Most studies have used a single recording of activity or diet as a measure of exposure. While it is assumed that such point estimates are correlated with habitual exercise or intake, it is uncertain what period of time is necessary to obtain the most valid estimates

 

Status 2016-08-24

Saw an unbelievable sight when I woke up at 5 AM. My blood glucose reading was 100. I can’t remember ever seeing 100 when I was pumping Insulin.

Weight is down a couple of lbs in the past couple of days. Wish I had started tracking from the start. I am down 16 lbs from Aug 5th. My rough guess is about 20 lbs so far since I started IF on July 31.

My blood sugar readings average in the past 3 days has been 115. That’s down from my previous 7 day average of 125. Also, I did switch to the Bayer Contour Next and it reads a bit higher than the OneTouch UltraLink I was using before.

So, all of the trends are good. I’ve been trying hard on the diet to eat higher fat and lower protein. Seems to be paying off. Combining LCHF with IF looks to me to be the cure-all for Type 2 Diabetes. At least in me. Your mileage, as they say, may vary.

Still taking Metformin 2x, 625 mg. Stopped taking  Avorstatin. Considering stop taking Niacin since it is listed as raising blood sugar when taken in combination with Metformin.

 

Caloric Restriction vs Intermittent Fasting

A 2011 Meta-Analysis (Obes Rev. 2011 Jul;12(7):e593-601. Intermittent versus daily calorie restriction: which diet regimen is more effective for weight loss? Varady KA.) looked at the difference between calorie restriction and Intermittent Fasting. The study looked at 18 trials and examined the results across each of them. 11 of the trials were for Caloric Restriction alone and 7 were for Intermittent Fasting.

The study termed both diets as Calorie Restriction because they both result in less net calories. The fast day wasn’t an actual fast, but a caloric restriction to 25% of a normal day. The difference is on the feed day the subjects could eat whatever they wanted to eat.

The conclusion was interesting.

In sum, intermittent CR and daily CR diets appear to be equally as effective in decreasing body weight, fat mass, and potentially, visceral fat mass. However, intermittent restriction regimens may be superior to daily restriction regimens in that they help conserve lean mass at the expense of fat mass. These findings add to the growing body of evidence showing that intermittent CR may be implemented as another viable option for weight loss in overweight and obese populations.

Another great result for Intermittent Fasting!

I know as a dieter which I would prefer. If you told me I had to diet every other day and could eat what I want on the other day and that I would do just as well as if I had dieted every day that doesn’t sound like a hard choice at all.

Another study reached similar conclusions (Am J Clin Nutr. 2009 Nov;90(5):1138-43. Short-term modified alternate-day fasting: a novel dietary strategy for weight loss and cardioprotection in obese adults. Varady KA1, Bhutani S, Church EC, Klempel MC.).

Here’s a third study on Alternate Day Fasting (Journal of Diabetes & Metabolic Disorders201312:4 The effects of modified alternate-day fasting diet on weight loss and CAD risk factors in overweight and obese women. Samira Eshghinia and Fatemeh Mohammadzadeh).

This is a great look at the evidence in favor of Intermittent Fasting (SA JOURNAL OF DIABETES & VASCULAR DISEASE. Intermittent fasting: a dietary intervention for prevention of diabetes and cardiovascular disease? James E Brown,Michael Mosley, Sarah Al).

The conclusion is worth reading:

The use of intermittent fasting offers the potential to improve weight loss and enhance the cardiovascular health of overweight and obese individuals with type 2 diabetes and reduces cardiovascular risk. This type of intervention is cost-effective and associated with a low risk of adverse events.

 

Alcohol and LCHF+IF (Aug 23, 2016)

Lost my taste for alcohol and haven’t wanted one in a couple of days. Haven’t had one either. Wanted to want to have a beer last night and I know that the low calories I had eaten for dinner would leave me hungry so I tried to talk myself into going and getting a beer. Couldn’t do it.

Not sure if it is my desire to keep down carbs or just not enjoying the taste as much when I am on ketosis.

Surprised that it is noon and I am not feeling particularly hungry since my dinner was just a double paddy burger without a bun at Five Guys last night.

Starting to enjoy being in ketosis.

 

One Week Off Insulin (Aug 23, 2016)

I’ve been off Insulin for a full week now.

So why am I still alive? After all, I needed 100 units a day on the average just one month ago. But here I am. Still Alive!

So did I just decide to ignore my Blood Glucose levels and am I on the edge of dying? Hardly. I’m still checking multiple times a day – mostly now in disbelief at how well my blood sugar is being regulated by my body. My high today was 124 and my low so far today is 109. I never got numbers like that before day after day on Insulin.

For dinner last night I took the kids out to Five Guys Burgers and Fries. I skipped the fries. I ate a bunch of peanuts and more importantly had my burger “bunless”. The choice to replace the bun with lettuce was a good one since it took away about 40 grams of carbs and left about 1 gram. The fat ratio was good and the jalapenos, etc didn’t add much to the carb count but they did add to the flavor.

All of that made my Blood Sugar at 103 around bedtime.

Addendum : Still taking Metformin. Not out of the T2D woods yet.

Weight Loss Numbers

Weight Loss on LC-HF+IF is a very strange thing. It goes in real spurts. Yesterday I dropped two lbs. Last week I had two days in a row where I lost five lbs each day. Most days I am about the same or down just a fraction of a lb.

I am down 14 lbs from a couple of week ago. I didn’t weigh myself at the start so I don’t know what weight I was to start with. I think I weighted 292 on the work scale (clothed of course).