Retrospective #353: Advice for a friend who is “pre-diabetic”

“I 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 just by eating “lower carb,” you are in a metabolic balancing act 1) to control your genetic predisposition to be Insulin Resistant (by eating fewer carbs -- to control both your blood sugar and blood insulin), 2) to maintain your weight loss, and 3) to do this without hunger. If you are successful, you will secure the reversal of the sliding scale you were on that was leading to your progressively worsening blood sugar control – even with medication – and to your eventual diagnosis as a full-blown Type 2 Diabetic.

“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 (ALL carbohydrates!). 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 Insulin Resistance and, despite medical therapy (more pills and eventually injected insulin), developing the inevitable complications. If you do this now, you will be able to cheat more than someone like me who learned much too late. Your genetic predisposition -- to become a Type 2 -- has been checked in time, I think. 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 (e.g., “nervous eating,” #348). 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.’ Because I eat Very Low Carb, 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 fasting glucose returns to ‘my normal’ (90s) easily. 

“In your case, you want to stop losing weight (but maintain your weight loss), and continue to remain insulin sensitive, and avoid hunger. To do this you need to continue to eat Low Carb (to keep you blood insulin level low and thus preserve access to body fat, plus eat more fat! Body fat is now recognized as an active organ, not a static blob. As long as you keep energy going in and out of the fat organ, you will be a fat burner, with a stable blood sugar, not a sugar burner where your blood sugar in on a roller coaster (from carbs you eat) and your energy level rises and falls. In other words, you’ll be 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).

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 in part by dietary carbs, so your blood insulin level (with incipient IR) never goes down. And as a consequence, your Insulin Resistance will continue to worsen. And because your body won’t have access to body fat, you’ll get signals from your body that you are hungry. It will tell you to eat something because 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 eat carbs only One Meal a Day, or from time to time, or on special occasions, like making deadline. NOT every day at every meal!