Retrospective #56: Metabolic Disregulation

The current buzz words in nutrition are “healthy eating,” a good thing to be sure, but insufficiently defined as it applies to the rapidly growing percentage of the US population that already has a dysregulated metabolism. In 2019, this is now the vast majority of the US population. A recent report cited by the Nutrition Coalition found that only 14% of adults in the USA were “metabolically healthy” without meds. That’s a stunning statistic.

When I originally posted this column in 2012, I noticed that many bloggers in the ‘nutrition sphere,’ including many of the most cutting-edge and scientific ones, had drifted away from low-carb to Paleo, then to Paleo with “safe starches.” Sadly, most of these bloggers also did not clearly differentiate between “healthy people” and people who have developed issues with metabolic regulation. Significantly, and here’s the crux: Neither does the American Diabetes Association, the USDA’s Dietary Guidelines for Americans or the public health establishment in general. Just ask almost any traditionally-schooled clinician, Registered Dietician (RD) or Certified Diabetes Educator (CDE).

Metabolic Disregulation most commonly manifests itself in weight gain. It is also in associated with hypertension (high blood pressure), dyslipidemia (high LDL and triglycerides and low HDL), hypercholesterolemia (“high cholesterol”) and Insulin Resistance (IR) with blood glucose disregulation producing Carbohydrate Intolerance. These multifactorial disorders are known collectively as Metabolic Syndrome (Scroll down to Retrospective #9).

I wonder at times if the clinician does not him/herself suffer from myopia. Or are they just among the lucky 14%. I lived with worsening Metabolic Dysregulation for most of my life, following doctor’s orders for 16 years after being diagnosed with hypertension and Type 2 diabetes in 1986…until, at my doctor’s suggestion to lose weight, I changed what I ate and fixed it all. So, I think this is worth bragging about, for educational purposes of course.

It began the day my doctor, ironically, suggested I try the Atkins diet. I followed Atkins Induction (20g/d of carbs) for 9 months and lost 60+ pounds. A few years later, when I regained 12, I switched to Bernstein’s program for diabetics. I eventually lost 170 pounds and dramatically improved my lipid health, my T2DM and my hypertension.

Of course, over the 17 years since I began to eat this way, I have regained and lost some of the pounds I had lost. I did not, however, regain my pot belly, I’ve been off statins for over 10 years, my BP meds have been cut in half, and I remain off all anti-diabetic meds except Metformin and have retained all my HDL, LDL and triglyceride gains.

The largest audience of “seekers” on diet-related matters, I’ve noticed, are those with a weight issue. They may be a little overweight, a lot overweight, obese or even morbidly obese. Everyone wants to lose weight easily, without hunger, and permanently. I was and still am one of those. When I weighed 375 pounds, I wanted to lose weight. I followed my doctor’s advice, eat less (on a “balanced” diet), and I resolved to move more. I even spent time with his office RD. But her advice was the same as his, and whenever I lost a few pounds, I always gained them back.

So now, while my lipid panel appears to be permanently repaired, I am still Carbohydrate Intolerant. Although my IR is somewhat improved by the way I eat, and by Metformin, I still cannot tolerate more than 5% to 10% carbs in my diet. I also know that “healthy eating” for me means this is the way I must eat to not regain the weight I lost.

I must be resigned to the fact that some of us cannot tolerate more than small amounts of carbs, and probably will never be able to do so. There is a failed mechanism in my metabolism such that for me it is “just too late.”

As this becomes clearer to me, or perhaps as I come to accept what is already pretty clear, that will mean that I need to adopt for the rest of my life the Way of Eating that I followed when I lost 170 pounds. That is what someone who has T1DM or is gluten and/or casein intolerant has to do. Except that for these folks – and I know a few people who have one or both of these condition – they don’t have a choice. They will die literally (the Type 1s), or wish they would (figuratively), if they don’t follow a strictly prescribed way of eating all day every day.

I’m lucky. I can cheat once in a while and get away with it. But, I still have a disregulated glucose metabolism.