A Dietitian’s Journey – four month update (with lab test results)

It’s been 4 months since I began my own weight-loss journey, following a low carb high healthy fat diet and I’ve been to the lab and had my blood tests.  Here is an update on my progress to date.

Blood sugar

Fasting blood sugar

When I began this journey at the beginning of March, my fasting blood glucose was averaging 12 mmol/L – and this was when I was eating the ‘standard recommended diet’ for someone with Type 2 Diabetes. My diet was high in complex carbs, and low in saturated fat. Also, as has been traditionally recommended for someone with Type 2 Diabetes, I ate 3 meals per day and made sure to have 2 – 3 snacks per day (each with complex carbs and some protein).

Now, four months into eating low carb high fat, my fasting blood sugar is averaging 8.5 mmol/L. It is significantly better, but not what I had hoped which was to be at or below 6.0 mmol/L (below the Diabetic cutoff range) in this time.  There were factors that I was not considering.

Firstly, my blood sugar has been persistently high in the morning since I have been in nutritional ketosis – significantly higher than 2 hours after a meal.  At first, I couldn’t figure out why. I’d been tracking my blood glucose at various times of the day; fasting, before I eat, 2 hours after I eat, before bed etc., but regardless what I ate the night before, it was highest in the morning.  It was then that I began to suspect that the effect of the hormone cortisol might be a factor. 

Cortisol is our “fright and flight” hormone and under stressful conditions, such as being chased by someone or something, cortisol  provides the body with an immediate source of glucose by breaking down our glycogen stores in our muscle and liver (a process called glycogenolysis) and uses them to manufacture glucose in the liver (a process known as gluconeogenesis).

All hormones have a natural cycle of rising and falling throughout the day and this is known as a hormone’s circadian rhythm and over the course of the night, cortisol production begins to climb around midnight and reaches and is highest level between 6 am to 8 am.  When I began to track my blood sugar from 10 pm until 8 am, I noticed that it would start going up in the wee hours of the morning and keep rising until 6:30 or 7 am, am when I would take it. It was then that it became evident that my fasting blood sugar was rising with cortisol.

Chan S, Debono M. Replication of cortisol circadian rhythm: new advances in hydrocortisone replacement therapy. Therapeutic Advances in Endocrinology and Metabolism. 2010;1(3):129-138. doi:10.1177/2042018810380214.

When we sleep, our body breaks down the glycogen stored in our muscle and liver and converts it to glucose for our blood – an entirely normal process. Since I am following a low carb high fat diet and have been in nutritional ketosis for while, my body uses ketones as its primary fuel source and make all the glucose it needs for my blood from the protein and fat in my diet. When it runs out of that, it burns my stored fat for fuel – which is exactly what I want it to do! Since I’d been keeping my carbohydrate intake consistent but not very low, when cortisol levels would rise over night, my body would break down my glycogen first, then my own fat stores to make glucose for my blood, which I suspect is the origin of my high fasting blood glucose. That, combined with my liver still being insulin resistant, the glucose has no where to go.

This made sense to me and explained why my fasting blood glucose remained high, despite no carb creep (more carbs than planned for).

Since I’m keeping myself in nutritional ketosis, I’m not concerned about my fasting blood glucose remaining higher, although I may try distributing my carbs differently – with fewer at night. Since my goal is lower insulin resistance, I am going to continue to focus on that. High blood sugar is a symptom.  The problem is insulin resistance.

My blood glucose 2 hours after meals has been getting better. It is now averaging around 6.0 mmol/L (sometimes hovering around 5.5 mmol/L) which is much better than 7.2 – 8.6 mmol/L which is what it was at the beginning of March. My goal is to see it consistently below 5.0 mmol/L after meals by mid-November.

HbA1C – glycosolated Hemoglobin

Glycosolated hemoglobin (HbA1C) is the hemoglobin in our red blood cells that gets sugar molecules attached to it proportional to the amount of sugar in our blood. It is used to measure the three-month average plasma glucose concentration, based on the fact that the lifespan of a red blood cell is four months (120 days). The advantage of this test, is that one does not need to be fasting to have it.

HbA1C is most strongly correlated with fasting blood glucose (as opposed to pre-meal blood sugar or to 2 hour post-meal blood sugar) and since my fasting blood glucose has been consistently high, my HbA1C results naturally reflected this.  Lab tests indicate it is 7.5%, which is above the upper cutoff for Type 2 Diabetics of 7.0% – and higher than what I was aiming for, which was below 6.0%, the Diabetic range cutoff. However, since neither fasting blood glucose nor HbA1C  measure what I am trying to change (which is insulin sensitivity), I’ve decided that in November, I will pay to have my fasting insulin re-assessed.  After all, the goal is to lower insulin – which underlies the high blood sugar!

Lowering Stress

I knew that I needed to get my cortisol levels down, as cortisol drives appetite, which drives eating which in turn, causes insulin to be released. More insulin means my body will be focused on fat storage, not fat burning which is the opposite of what I want. Since my goal is lowering insulin resistance, lowering cortisol makes sense. Since I can’t change cortisol’s natural circadian rhythm, I had to focus on lowering the whole curve!  Lowering stress wasn’t going to happen sitting at my desk working. I had to get moving.  More on that, below.

Blood Pressure

As mentioned in my last update, a month ago I asked to be started on a very low dose of Ramipril (Altace), as my blood pressure had begun to creep up again. When I saw 160/90 mmHg two days in a row, I went to see my doctor.  He wasn’t there, but the locum agreed with my assessment that it was wise to protect my heart, brain and kidneys while I continued to make the dietary and lifestyle changes.  She asked me to delay getting my blood work for a few weeks, to assess my electrolytes (sodium and potassium) level which can be affected by the medication.

Even two years ago, my potassium was at the high end of normal – and this was when I was dutifully eating a diet high in complex carbs and low in saturated fat, as I ate a diet high in potassium-rich foods.

This time my potassium was at the upper normal limit, so I’m tracking my intake of it and keeping it approximately 1/3 to 1/2 of what it was previously.

Taking the blood pressure medication is a temporary measure that I decided on in order to offer some protection against heart attack, stroke and kidney damage until I lose more weight, and my blood pressure stays down on its own.

Thankfully, my overall kidney function is now better than it was 2 years ago, although I did need to make a few dietary changes to be sure that I avoid getting kidney stones (something that runs in my family).  When I started exercising regularly a month ago, I didn’t adequately increase my water intake – which I’ve since corrected.  I had also added a calcium supplement when I stopped drinking milk in March and which was binding with certain food components in the veggies and nuts I was eating.  This was probably what was resulting in calcium-oxalate being detectable in my urine. I’m no longer taking the calcium supplement and have added more hard cheese into my diet, instead.

Cholesterol

My LDL was at the high-end cutoff two years ago, but after 4 months on a low carb high healthy fat diet, it is approaching what is considered by the existing / popular standards of “optimal LDL” for someone who is high risk (family history of cardiovascular disease). My LDL is 2.60 mmol/L (1.14 mg/dl), my triglycerides (TG) were 0.64 mmol/L and my HDL was 1.97 mmol/L

Using more significant measures, my TG:HDL ratio is now 0.32 (with <0.87 considered ideal). According to several studies (that I will go into more detail in an upcoming article), a very low TG:HDL ratio is associated with lots of large, fluffy LDL – the kind associated the lowest risk of cardiovascular disease (CVD) such as heart attack and stroke. It is the higher density, small LDL particles that are associated with CVD.

Walking

A month ago, I began walking every morning during the weekdays.  I had just fractured a rib (slipping washing a bathtub!) and read that walking was good to reduce pain. Since reducing pain was high up on my “to do” list, I started with walking 1 km each morning during the week, before I began my office hours.  I gradually increased it to 2 km. The last week and a half it has been 3 km.

At the beginning of last week, I saw a fellow who was in very good shape using Nordic walking poles, so I asked him why he used them. He explained that as he digs the poles into the dirt on the path and pushes himself off of them, it gives him a good upper body as well as the lower body workout that comes from walking briskly. I decided to get myself some.

I researched what height they needed to be and decided whether I would get adjustable height ones or not, and purchased them on Friday and over the weekend, I read about how to use them properly. It seemed as thought it would be pretty intuitive for me, given that I have (and use) a Nordic Track ski machine when the weather is not conducive to going out to exercise.

Nordic Walking Poles

I was skeptical that using them could actually increase the calories I burned by 30%, for the same distance walked until I tried them this morning.

I am no longer skeptical!

I was very well aware of how much better a workout I had gotten after 2 km, but did another 1 km anyways.  I can’t wait to go again tomorrow.

Getting Even More Serious

Reducing Carbs

A month ago my weight was still ‘stuck’ at its 6 pound weight loss, so I decided to reduce my carbs slightly but consistently and to monitor my intake of nuts and dark chocolate, which could easily cause me to exceed my carb ceiling.

Bingo!

Intermittent Fasting

Monday – Friday I wasn’t hungry in the morning, because I would eat a very satisfying meal the night before (with adequate protein and lots of healthy fats and low carb veggies), so I was and am quite content to have only a coffee and cream for breakfast, and then go for my walk.

When I come home, most days I’m really not hungry, because my body had finally figured out how to burn my own fat stores for energy!

At first when I started exercising (nothing crazy…I was just walking briskly!) and delaying the time between meals, I needed to monitor my blood sugar even more often as it could get quite low in the late afternoon before dinner (+/- 4.0 mmol/L) – at which point I would eat something as I prepared dinner, to raise my blood sugar.

Here is a graph showing my blood glucose since I started walking and intermittent fasting;

Blood glucose since beginning walking and intermittent fasting

Weight Loss

In the last 3 weeks, my weight has dropped another 4 pounds, making it a total weight loss of 10 pounds, in all so far.  I expect as I continue to walk 4 days a week and intermittent fast most weekdays and limit my carbs, that the weight and inches will continue to come off.

I am not suffering in any way!

As a Dietitian, I talk about or write about food all day long and I’m intermittent fasting and feel just fine! I’m not hungry.  As I jokingly posted last week;

“My body has finally figured out how to make glucose from my fat on a low carb high fat diet. I may potentially have found the source of immortality.

Final Thoughts…

I still have at least another 30 pounds to go to get to the “goal weight” that I set at the beginning of this journey, and am now aiming to lose another 40-45 pounds instead in order to reach my ideal (healthiest) waist to height ratio. I clearly won’t accomplish this by mid-November, but if I reach close to my initial goal weight, I will be quite content.

They say a picture speaks a thousand words, so below are two photos. The one on the left, with the blue shirt is me at the beginning of this journey.  The one on the right, with the burgundy shirt is me now. I am starting to see a face I recognize.

Have questions?

Want to know how I can help you reach your own nutrition goals? Please send me a note using the “Contact Us” form above, letting me know how I can help.

To our good health!

Joy

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Note: I am a "sample-set of 1" - meaning that my results may or may not be like any others who follow a similar lifestyle. If you are considering eating "low carb" and are taking medication to control your blood sugar or blood pressure, please discuss it with your doctor, first.

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