Type 2 Diabetes, a Dietary Disease #353: Advice for a friend who is “pre-diabetic”

“Just remembered, I didn’t answer your ‘other news’ question,” I emailed her back. Then, I continued:

“As you now realize, having just lost over 20 pounds, you are in a metabolic balancing act 1) to control your genetic predisposition to be Insulin Resistant (by managing what you eat -- i.e. eating fewer carbs -- to control both your blood sugar and blood insulin), 2) to maintain your weight loss (i.e., to not lose more and not gain), and 3) to do this without hunger. If you are successful, you will secure the reversal of the continuum you were on that was leading you to progressively worsening blood sugar control – even with medication – and eventually to full-blown Type 2 Diabetes Mellitus.

“You learned that you could reverse your ‘pre-diabetes’ by managing your diet. You learned to do that because you “ate to the meter,” testing your blood sugar before and after eating suspect foods. Because you acted in time, your ‘pre-diabetes’ had not progressed to where you’d seriously damaged your pancreas and developed non-reversible Insulin Resistance (IR). If you continue to eat the way you have learned for the rest of your life, you should be alright. You really have no other choice, unless you’re willing to accept progressive worsening of your IR and, despite medical therapy (more pills and eventually injected insulin), developing the inevitable complications. Your way allows you to cheat much more than someone like me who learned much too late. Your genetic predisposition -- to become a T2 -- has been checked. Congratulations!

“With respect to your ‘hunger,’ there is of course the possibility that this may be something other than your body telling you that you need energy from eating something. But if it is actually hunger, here's what I think: N.B., your body and mine are in different metabolic states, so what I am telling you now is my understanding of how the body’s mechanisms work for someone in your current ‘state.’ My body is never hungry so long as I abstain from eating more than a minimum number of carbs. My body is always being fueled by fat, in my case both dietary and body fat. Both are triglycerides and break down to fatty acids. I eat plenty of fat, and I have plenty of stored fat on my body. So, my metabolism is always running in high gear. I am pumped. And my blood sugars are stable. I can even cheat because by always keeping my blood sugar and blood insulin levels ‘low,’ and by taking 750mg of metformin twice a day, my insulin sensitivity has improved. That means when I cheat, the sugar in my blood is taken up and my FBG returns to ‘my normal’ (90s) more easily. 

“In your case, you want to stop losing weight (and maintain your weight loss), and continue to remain insulin sensitive, and avoid hunger (a sign of a restricted calorie diet and/or a roller coaster blood sugar. In other words, instead of letting your body use either your body fat or ingested fat for energy (thus maintaining a high energy level, i.e. always feeling pumped like me, and keeping a stable blood sugar), you need to use only dietary fat, that is, fat that you ear. If you instead eat carbs with every meal (together with fat and protein), your blood sugar will fluctuate, even if it returns to "your normal" (low 100s) one or two hours after eating. Your metabolism is being fed both dietary carbs and dietary fat for energy. So, your blood insulin level never goes down. And because your body won’t (and you don’t want it to) burn body fat, you get signals from your body that you are hungry. It tells you to eat something because (as you intend) the path to letting your body break down its own fat for energy is blocked by the constantly elevated blood insulin level.

“Your solution: Skip carbs altogether for one or two meals a day. Try limiting them only to supper, say, or breakfast if you must have that "chocolate cocktail" you seem to enjoy. Eat mostly fat and protein for energy, and just eat carbs from time to time, on special occasions, like making deadline, not every day at every meal!

“I don't always listen to my own advice,” I told my friend, “but I have found this little piece really works well for me: When I feel the urge to eat something, I ask myself, "Am I hungry?" Invariably the answer for me is ‘no.’ Sometimes I eat anyway, but more and more often I am deciding not to. Learning how to do this is about changing habits, and giving up comfort foods. It is also about an emotional/psychological/need. In my case, when I answer ‘no,’ I find an alternative to eating. Reading or writing (or a happy hour spritzer or two) works for me. I would think this would work for you too. As I turn to something else, the ‘need’ goes away.”