Thursday, April 2, 2020

Retrospective #411: “You don’t eat!”

When the lab report arrived in the mail, I was expecting to see an increase in my A1c. Instead, my A1c dropped another 0.1% to 5.2%. When I expressed surprise to my wife, she blurted, “I’m not surprised. You don’t eat!”
It’s true. I’m not hungry when I fast because, when I do eat, I eat Very Low Carb (VLC). As I result, my body is fat-adapted. It obtains all the energy it needs from the fat I eat and then the fat my body has stored for the purpose, and I still have plenty of that. So, my energy level, i.e. metabolic rate, remains high because when my body fat breaks down, it is used to maintain energy balance. This fat burning process will continue so long as I eat Very Low Carb. While glucose and insulin levels in the bloodstream remain low, the body will feed freely, as needed, on its own fat.
In retrospect, my concern that my A1c would rise was unfounded. I didn’t take into account that I had only been fasting for 2 days a week – and for just 2 months – when blood was drawn in April. The A1c test measures glucose on the surface of red blood cells over 3 months. So, when the A1c blood was drawn, I still had some “old” red blood cells circulating. Plus, after April I increased my fasting from 2 days a week to 3 days a week.
But my wife, feeling like she was “on a roll,” continued, “That’s why we don’t go out to eat as often as we used to….and you’ve saved a lot of money by our eating out less often. My rejoinder was that I only fast 3 days a week, and that still leaves 4 days a week for eating out! So, my standing offer, to eat “out” as often as she would like, still standsand look at all the money she’s saved by not needing to buy food-for-two for 3 days a week! She agreed, and our “Bickersons” episode ended…strangely, I think, because she usually gets “the last word.”
Bottom line: If you don’t eat, you’re going to 1) lose weight and 2) save money. The secret is: doing it without hunger and without harm. Ketosis is the answer. It is “the normal state of man,” according to the NIH’s Richard L. Veech, (and a host of other researchers in human metabolism). Ketosis begins when your body has finished digesting and absorbing your last meal and begins a period of fasting. The length of time before entering this state differs only by how long it takes to use up the glycogen stored in the liver from previously digested carbs.
In addition, when I don’t eat and continue to take Metformin as prescribed, my blood sugar is better controlled. When I asked my doctor to increase my dose from 500mg once a day to 750mg twice a day – a “therapeutic dose” – and started my 300kcal/day modified fasting regimen, I sometimes got fasting blood glucoses as low as the 60s, without hypoglycemia. When I told my doctor, he laughed. “You can’t get hypoglycemia on Metformin,” he said. Now, when I follow VLC strictly, my FBGs are typically in the 70s and 80s. A recent weekly average was 81mg/dl. And I haven’t had a hypo since 2002 (when I was heavily drugged before I began to eat Very Low Carb).
So, eating Very Low Carb and fasting 2 or 3 days a week is a win-win-win: You lose weight, you save money, and you and your doctor are pleased that your blood sugar control has improved to the point where I am, clinically speaking, now “non-diabetic.” And, when you have better blood sugar control, you reduce your risk of cardiovascular disease (CVD). Type 2s treated with “Standard Care” have twice the risk of CVD as “normal” people. And if you’re been diagnosed with heart disease, you have an even higher risk. See “How Diabetic Do You Want to Be?” to learn more.
Naturally, the question arises: Would it be possible to get an A1c lower than 5.2%? Maybe even in the high 4s? By diet and Metformin alone?  I think it is possible. I also think I can continue to lose weight. When you read this (originally posted in late 2017), I will have lost 185 pounds, and be just about “half the man I once was.” My target final weight (then) was 171-175 pounds* or “200 pounds lost.” And then, presciently, I realized the hardest goal of all would be: Maintaining that weight. I imagined it would involve Very Low Carb, One Meal a Day, and my “300kcal full-day fasts” for 2 or maybe 3 days every week. I’ll call it my VLC/OMAD/4-3 diet. I should be there…in the not-too-distant future.
* My target weight is now 195 to 199 pounds, a permanent loss of 180 pounds. It’s an elusive goal, but, C’est la vie.

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