A Dietitian’s Journey Progress Report – is the glass half empty or half full?

Ten months ago, it was urgent. I had to make a choice between going on several types of medication to lower my crazy-high blood pressure, and high blood sugars, triglyceride and LDL cholesterol or to immediately change my lifestyle.  I chose to change my lifestyle. This is a progress report, going into the final two months of my first year at this.

As with other changes we undertake, there are two ways to look at things; how far we’ve come or how far we have to go. I choose to look at my progress as both. I am certainly not “there” yet, but I am nowhere near where I was!

Back in early March of this year, when I faced my own personal health crisis, it had been two years since I had any lab work done and ages since I was monitoring my blood sugar myself, even though I was Diabetic for the previous 10 years.  It really was a case of classic denial. I didn’t want to know how bad it was. That day because I didn’t feel well, I faced the truth.  I took my blood pressure (multiple times, because I couldn’t believe the readings!!) and I took my blood sugar. My blood pressure was so high, for certain had I gone to see my doctor at that point, he would have prescribed at least one type of medication, maybe two. Suffice to say it was dangerously high.

My blood sugar back in March of this year was high, but what else could it be eating a carb-based diet.  I had started eating low carb two years earlier, but life circumstances got in the way for a time and I failed to go back and pick up where I left off. As I could have predicted they would, things only got worse. My fasting blood sugar was between 13.0 mmol/L (234 mg/dl) and 9.0 mmol/L (162 mg/dl).  That’s nuts!

I was obese (BMI > 30). I’d joke about being the “fat Dietitian” but it wasn’t funny.  For the previous two years, I was teaching others to eat low carb high healthy fat in order to lower their weight and reduce their insulin resistance, but I was in classic denial when it came to myself. Yes, I knew I was fat, but I was in denial as to just how much risk I was at for a heart attack or stroke.

My LDL was high and even though my high HDL acted as a protective factor, in the context of me being Diabetic, obese and having very high blood pressure, the only place it was going to go was higher – unless I changed my lifestyle permanently.  That day I did. For me, there really can’t be any turning back as it really is a matter of life and death. I am no longer in denial.

So how am I doing?

The weight has been coming off, slowly but surely. I haven’t made any major progress in the last month, but then again I didn’t gain anything of significance over the holidays.  That’s a good thing.  Okay, it’s a very good thing. Looking at it with the ‘glass’ being half empty I am still only 1/2 way to where I need to be to have my waist circumference 1/2 my height. Looking at it with the ‘glass’ being half-full, I’ve lost 30 pounds.  I feel better about how I look than I have in many years, and I am only half way there.  I am celebrating my progress, but not letting it be enough because health-wise, it isn’t. To truly reduce my risk of heart attack and stroke, I need to lose another 30 pounds, or whatever weight will actually put my waist circumference at half my height.

I’ve loss 6 inches off my waist. That’s 1/2 a foot!  Crazy, eh?  I only have another 4 inches to lose off my waist for me be in the low-risk category and I am guessing that will correlate to another 30 pounds of weight loss.  Maybe it will be less, maybe more, but my weight loss goal is whatever it takes for my waist to be half my height. The scale won’t determine my goal, the tape measure will.

My blood pressure has been ranging from between just below the normal range to pre-hypertension for months, but to protect my kidneys I am continuing to take a “baby dose” of Ramipril® (2.5 mg per day) that I asked the doctor to put me on until my blood pressure is consistently below normal and the meds need to be reduced or discontinued.  The dose I’m on is the smallest it comes in and my doctor has switched me to tablets, which can be split if my blood pressure is consistently on the low side.

As covered in an earlier update, my triglycerides and cholesterol are now in the ideal range simply from the dietary changes I have made.

My blood sugar has been a bit frustrating, because overall it isn’t going down nearly as fast as I thought it would, or as I’ve observed other people’s to do. Everybody’s different and mine is just taking this long despite all the things I am doing right. I started out eating “low carb” (50 gm carbohydrate per day) and as it turned out it wasn’t low carb enough, perhaps because of how long I’d been Diabetic and just how insulin resistant I really am. A few months ago, I added regular intermittent fasting (IF) – fasting 23 hours from the end of supper to the beginning of supper the following day (drinking ‘bone broth’ and tea and other appropriate beverages while fasting). I have done one slightly longer fast, with careful monitoring. Along with IF, a number of months ago I also lowered my carb intake to ≤ 35 gm of carbs per day and monitor my blood sugar 5-7 times per day to make sure it doesn’t dip too low.  During the day time, towards the end of a 24 hour fast, my blood sugar will be in the low 4’s mmol/L (~81 mg/dl) just before I eat again, but in the morning, the lowest it has ever been is 5.8 mmol/L (105 mg/dl).  No matter what I do the night before (i.e. exercise, eat very low carb) my blood sugar begins rising around 3 am and continues rising until 6 or 8 am, even though I am fasting.  It is classic “dawn phenomenon” and it has been incredibly frustrating.

My HbA1C has dropped from ~9.0 % (at the beginning of March) to 7.5 %  (July 25 2017) to 7.0 % (October 11 2017) in 7 months, but for the last 3 months it has remained stubbornly at 6.8 % – almost exclusively because my fasting blood sugar remains high. This led me to a decision to ask my doctor to trial me on a “baby dose” of Metformin® only at night to see if it will help bring down my fasting blood sugar and more importantly, the corresponding insulin resistance, while I continue to eat a very low carb (ketogenic) diet and practice intermittent fasting.

After reviewing the over 400 glucose readings I took from March 5, 2017 onward and seeing that my HbA1C remains only slightly lower the last 3 months despite all my lifestyle changes, my doctor agreed to trial me on the lowest dosage of Metformin® over the next 3 months (the dose given to youth with high blood sugar).  It will be interesting to see its effect as of January 6, 2018. What many people may not realize is that while Metformin® is now a pharmaceutical (medication), it was initially derived from a plant called “goat’s rue” or the French lilac and has been used since the Middle Ages to treat the symptoms of Diabetes. It’s not unlike acetylsalicylic acid (ASA), which is the active compound in Aspirin® which was originally isolated from white willow bark.  Aspirin® and Metformin® are both natural in origin.

In addition to its natural origins and long-standing safety record, studies indicate that people with Diabetes who take Metformin® have lower  incidence of cancer and dementia and in animal models, increased longevity has also been reported.  Given all of these factors, it seemed reasonable for me to ask my doctor to trial me on a small dose of Metformin® to see if it keeps my liver from manufacturing too much glucose in the early hours of the morning, thus lowering my overall insulin resistance, while I continue to eat ketogenically and practice intermittent fasting. My doctor agreed. While it is too soon to know how much impact this small dose will have, from January 6th until today, my blood sugar is averaging 6.5 mmol/L, yet still rising from 3 am until 6 am. I will give it a few more weeks and then possibly ask my doctor to try me on the same dosage of slow-release Metformin®, to see if my morning blood sugar is improved.

It may seem strange to some that I would add medication after successfully having lost so much weight, having brought my lipids into the ideal range  for non-Diabetics, and having lowered my blood sugar to the ideal range for Diabetics (≤ 7.0%) solely by adopting a low carb lifestyle and practicing intermittent fasting. I view much it like wearing a brace or using a cane after injuring one’s knee. It’s not a permanent measure, but support and protection while the healing continues to take place.

This is my journey, and my progress and challenges are as individual as I am. Everyone is different and the degree of carb reduction and whether or not intermittent fasting may be helpful for you is something that will only be known it time as we work together.  One thing is for certain is that unless one starts the process of working towards achieving their health and wellness goals, things will not improve on their own.

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To our good health!


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