Wednesday, January 14, 2015

The Nutrition Debate #279: My fasting blood glucose is 85mg/dl

My Fasting Blood Glucose (FBG) was 85mg/dl (4.22mmol/l) this morning. That’s not “normal” for me. I have a “broken glucose metabolism.” It has been broken for more than half my life. I am Carbohydrate Intolerant. I was diagnosed a type 2 diabetic over 28 years ago (1986) and was probably diabetic for a few years before. I was certainly “pre-diabetic,” with Impaired Glucose Tolerance (IGT) and then Impaired Fasting Glucose (IFG) for years. That’s how my type 2 diabetes was spotted. On my first office visit, an observant GP saw that I was obese and ordered a fasting plasma glucose test. Voilà.
In those days the threshold for a diagnosis of type 2 diabetes was two consecutive lab tests of 140mg/dl or more. (Today it’s 126mg/dl and an A1c test.) That doctor, whom I only saw once (I moved), and whose name I don’t even remember, did the usual thing in those days: he prescribed a sulfonylurea, micronase (generic: glyburide), and undoubtedly advised me to lose weigh by “eating less and exercising more.” The “medically advised” diet in those days hewed to the newly formulated Dietary Guidelines for Americans, first promulgated in 1980 and updated every 5 years afterward. Unbelievably, it still does.
Of course, as everybody knows, it’s virtually impossible to lose weight and keep it off on a calorie-restricted, balanced diet. Your body “craves” more. It doesn’t want you to “starve.” So it’s constantly signaling that you’re “hungry.” I put all these words in quotes because they have become part of the lexicon of dieting by this failed meme. You know it. I know it. You would think that individual medical practitioners would (actually do?) know it, but the profession today is more a business that is governed (for most docs) by the “bottom line” and the “standards of practice” they must follow in order to be paid for the medical codes they submitToo bad for us that the government has intervened in the patient-doctor relationship.
So, how did my blood sugar get to be 85mg/dl this morning?  Briefly, on the restricted-calorie, balanced diet my weight (300 in 1986) continued to rise until I weighed 375 pounds in 2002. And my oral anti-diabetic medications increased as well until I was maxed out on two drug classes and starting a third. Before long, I would become an insulin-dependent type 2, if I didn’t change my Way of Eating (WOE). Newer drugs were not yet available.
Then, one day in 2002, on a regular office visit, my doctor said to me, “Have I got a diet for you!” A few months earlier he had read the Sunday Magazine cover story in the New York Times: Gary Taubes’ “What It It's All Been a Big Fat Lie.” He tried the diet himself, lost 17 pounds, liked his blood lipids, and decided to “prescribe” the diet for me. I was ready. I was really motivated and willing to try something different. The diet was Atkins Induction, and I lost 60 pounds in the next 9 months – and then I retired. That was a major “lifestyle change,” but I managed to retain my new VLC “eating pattern.” 
But even before I lost this weight – upon starting Atkins Induction, actually – I started to get hypos, which are dangerously low blood sugars. I called the doctor, and he immediately told me to stop taking the 3rd med. The next day, when the hypos continued, he told me to cut the other two classes of meds in half. The next day he ordered me to cut them again. Eventually, I titrated off the sulfonylurea altogether and today just take a small dose of Metformin with supper. Over time, I saw my A1c’s drop to the mid 5s, my HDL-Cs double (from 39 to 84), my triglycerides drop 2/3rds from 137 to 49 average, and my hs-CRPs (an inflammation marker) drop from “high risk” to “normal risk” to “low risk” of cardiovascular disease
I kept the 60 pounds off for several years and then, over the summer of 2006, I regained 12. (It could have been those late-night freezer raids.) I recommitted to a Very Low Carb WOE and switched to “Bernstein” – Richard K. Bernstein’sDiabetes Solution “6-12-12 program” for diabetics. I lost 100 pounds in 50 weeks. Altogether I lost 170 pounds.
Along the way, until I learned (from my meter) what I could eat and what I couldn’t, my total calories on Atkins dropped (as my weight dropped) from over 2,000/day to 1,700 to 1,550 to 1,470, and eventually to 1,200 calories/day (375/375/450). My carbs of course have always been VERY LOW (from 8% down to 5% today). My diet is mostly moderate protein (25 to 20%) and high (70 to 75%) “good” fat: saturated and monounsaturated. I try to completely avoid polyunsaturated fats (PUFAs). PUFAs are vegetable and seed oils, like soybean, corn, sunflower and Canola oil. 
I eat 2-3 small meals a day, with no snacks at the moment. I’m trying to lose some of the pounds that have crept back on. If I were snacking, it would only be before supper, with sliced radishes with salt and ghee and diet tonic (vodka optional). I am not ever hungry. I have great energy levels and (at age 73) nohealth complaints. And when I eat like this for just a few days, my FBG drops from the low 100s to the 80s and 90s once again. What’s your Fasting Blood Glucose?


  1. This morning it was 78. HFLC works so well for me, as far as blood sugar is concerned. For weight control, though, I have to be really strict with calories, and it's easy to exceed those with the HF part of the diet. Like you, I'm not ever hungry and have no health complaints. I'm always amazed at how little food I actually require to do quite well. (Have been at this for 8 years). Last A1C, 4.9. My (perhaps stupid) doctor says, "I don't think you're really diabetic."

    1. Hi Jan,
      Isn't it amazing how really STUPID our doctors are, literally. It reflects their not understanding the basic underpinnings of the physiology of the disease condition, which is a lamentable statement of their medical education. All we can do is humor them, since it is beyond their ken to be educated by a patient. Congratulations on your A1c.

  2. Dan, I've been trying to add a little variety to my diet. The main reason it's hard is I keep pretty good track of what I've eaten. If I eat the same things, I can just cut and paste on my record file. Anyway, I thought you might find it funny that I bought some sardines and I've been trying to force myself to eat them. So far the cans are just sitting there. On HFLC, I haven't been hungry enough to try them.

    1. LOL. Btw, in a draft of an upcoming column, I say, "My editor cringes at the thought...(of eating a can of sardines for lunch). She deleted it and commented to me that she in fact DOES eat a can not every day but not infrequently either. She is convinced of the benefit. In fact, she believes it is the principal reason for my very low trigs and high HDL. As you will see when you get to see columns #281, #282 and #283, with lots of graphs, which she has just edited, the benefits are manifest.

      I buy (through Amazon) King Oscar brand Brisling sardines in extra virgin olive oil. They are "two layer, 12-22 fish" per can. I sometimes add salt and pepper, or even creole seasoning, or Montreal seasoning from McCormick on top. There are no bones, but they are skin on. The smaller the better. Brisling sardines are caught in the Baltic, not the Atlantic.

      Of course, you can buy "boneless, skinless" sardines, but as I said, unlike salmon in a can, there are no bones and I don't mind the skin or even the tails. They are so small.

      My caution is be careful not to buy ones packed in other oils (sunflower, soy bean, etc.); obviously, they contain too many n6s.

      My editor buys Bela brand; I have asked her what she likes about that brand.

      PS: It is because I have not been hungry at lunch that I skipped lunch for awhile; the result is that my trigs went up and my HDL came down, both to the worst levels in several years; needless to say, I am eating lunch again now, every day. I just decided to cut back on breakfast instead: 3 eggs to 2 eggs. My wife eats just one. We both eat 1 strip of bacon, and h&h or cream with our coffee.