Sunday, December 11, 2016

Type 2 Diabetes, a Dietary Disease #358: Ten years ago, I had a relapse (Part 3)

When I told my wife that I was writing a series about my weight loss journey since I started Bernstein 10 years ago this fall, she asked me if that was the year we were in Puerta Vallarta in September. I checked and it was. What a memory she has! My recollection was a little different…
As I related in “Ten years ago, I had a relapse (Part 2),” I recalled that my motivation was that I had regained 12 pounds (20%) of the 60 pounds I had lost on Atkins Induction (20g a day of carbs) back in 2002-03. That was true, but my wife reminded me of a conversation I had had with a Canadian MD I met in Mexico who told me that I was “IN DENIAL.” What a service that doctor did for me that day!
I came home with renewed resolve to do something about that 12 pound weight gain. Having just read Richard K. Bernstein’s “Diabetes Diet,” I bought and read his Diabetes Solution  and decided to go for it: eat just 30g of carbs a day. For medications, I was still 5mg Glyburide and 500mg of Metformin a day.
Beginning in October 2006, I started counting carbs and taking blood sugar readings again (see Fig.1  ). By November ( Fig.2), I had cut back the Glyburide from 5mg to 2½. In late January (Fig.3), I started a 4-week drug trial to reduce it further from 2.5mg to 1.25. And in late February (Fig.4), I started limiting proteins, since so many of their component amino acids are glucogenic, i.e., are made into glucose by the liver.
Then, on March 17,, 2007, I stopped taking Glyburide altogether. By April I was eating just 90g of protein a day (see #357 for how I chose this amount). In May, I reduced protein further to 80g/d. I also reduced my fat intake from 110 to 100 to 90g/day. By September 23, 2007 (Fig.5), 50 weeks after starting Bernstein, I had lost 96 pounds, going from 327 to 231. Added to the 48 net (60-12) that I had lost on Atkins Induction, my total weight loss from 375 pounds to 231 on both Very Low Carb diets, was 144 pounds…with more to come.
Remember too (or if you didn’t, read #356 here), starting with the first week on Atkins Induction back in 2002, I had stopped taking all of my oral anti-diabetic medications except 500mg Metformin and 5mg Glyburide.  Now I was only on 500mg of Metformin, which I was to continue for the next 14 years.
With all the weight loss, my blood pressure also improved significantly, on the same pill “cocktail.” It went from 130/90 to 110/70 at my lowest weight (late 2008). Currently it’s 120/75. And my lowest A1c was 5.4%.
Now, returning back to late 2003, after a year of monthly office visits while monitoring my 60 pound weight loss and maintenance while on Atkins Induction, my doctor suggested we change to quarterly visits. My Total Cholesterol and LDL-C hadn’t changed much. They were both “borderline” by NCEP Guidelines for a “healthy” person. But, based on my still “morbidly obese” status, and Type 2 diabetes, my doctor declared that I was still at “high risk” for cardiovascular disease, so he put me on a statin. He started me on Lipitor, and quickly raised it to the max. My LDL-C (and Total Cholesterol) responded as expected. They plummeted.
But, prior to my starting statins, on both Atkins Induction and Bernstein, my HDL-D and triglycerides both improved a little. Before starting Atkins, my average HDL-C had been just 39mg/dl and my TGs 143mg/dl. Now, my HDL was 51 average (range 43 to 60) and my triglycerides 84 average (range 36 to 157). As I continued from mid-2004 to mid 2007 on both Bernstein and a generic statin, Simvastatin, my TC and LDL-C were very, very low (TC: 116 & LDL-C: 48, average of 12); however, since starting on Bernstein, my HDL-C soared and TGs crashed. My HDL-C average was now 84mg/dl and my TGs averaged 49mg/dl.
Given the death-from-all-cause benefit of a high HDL-C and low triglycerides, and my total weight loss (by this point 170 pounds), on first, Atkins Induction, and then Bernstein, in December 2008 my doctor (on his own!) took me off statins. I have been statin-free now for 8 years. And while my weight has inched up a little, my latest lipid panel was Total Cholesterol 184, HDL-C 91, LDL-C 84 and triglycerides 46. How’s them apples?

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