By Disclaimer and Waiver of Liability: 1) This essay describes actual life events and the choices that I made to change a serious medical condition. I am not a medical doctor and if you read this and decide to follow my advice then that is your decision and you bear responsibility for that choice. 2) I have made references to the peer-reviewed literature and web sites—you should read them yourself and come to your own conclusions about prediabetic and diabetic reversal and also the current standard of care which keeps carbohydrates in the diet. 3) I have written authentically, and as such, you will encounter strong language in the essay.
Kill Diabetes Today
There are some things that I’ve come to expect in life. Like cave diving each summer in the Yucatan or waking up next to my wife each morning. Yet the older I get the more I realize that things change and that you should appreciate what you have because adversity is waiting to ambush you just beyond the thin fabric of what you believe is your truth.
For the past three years I have made CrossFit a major part of my life—either CrossFitting at home or in the gym three to five days a week. I’ve watched my cardiovascular fitness steadily improve and I was looking forward to seeing this years blood results.
That’s why when I opened the email from my doctor I nearly fell out of my chair. My blood sugar was high along with my A1C. In short, I was prediabetic! I was one step away from being a full blown diabetic.
I literally shouted, “What the fuck!” And read the email again. This was impossible, I thought. There’s no fucking way that I am on track to be a diabetic. These results had to be wrong. This sentiment was echoed by my wife and daughter. “There’s no way, Pete.” My wife said. “They made a mistake.”
I mean, after all, I don’t fit the stereotype: my cardiovascular numbers are excellent, I’m not overweight, I don’t eat sugar— I’m not one of these guys swigging Cokes and pounding pizza and cookies in the employee lounge. There had to be an error. I couldn’t be prediabetic.
I emailed my doctor. Could the high blood glucose be because of the coffees I’d had before the blood draw? Could the A1C results-(what the fuck was A1C anyway?)-be because of the holiday season? A season marked by mashed potatoes, sweet potatoes, dressing, ice cream, pie, etc.
No, the high blood glucose was not due to the black coffee. And to be clear about the A1C: A1C is the average glucose bonded to red blood cells by covalent bonds and gives you a measure of the average blood glucose levels over a 3 month period which is the lifetime of a red blood cell (https://en.wikipedia.org/wiki/Glycated_hemoglobin). I want to note for the reader that the Christmas holiday season had occurred right smack in the middle of the three month window of the A1C reading. Perhaps the holiday season with its massive meals heavy in carbohydrates had influenced the A1C value but I think my doctor was just being polite about that possibility.
I studied the lifestyle changes recommended by the doctor and I have listed them here for your convenience (This standard of care is quoted directly from my doctors email):
- Make natural or minimally-processed foods the basis of your diet.
- Make fruits and vegetables half of your plate at every meal.
- Try a Mediterranean diet focused on fiber (veggies, whole grains, legumes) and cooking with olive oil.
- Think of food with any form of sugar listed in the first few ingredients as dessert (this includes high fructose corn syrup, organic evaporated cane juice, agave nectar, and honey).
- Eat healthy fats like those found in olive oil, fatty fish, avocado, nuts & seeds, and grass-fed meat & dairy. Avoid hydrogenated ‘trans’ fat.
- Get aerobic exercise for at least 20 to 30 minutes three times a week.
Anyone following my blog knows that I’m a CrossFit athlete. Moreover, I’m in my third year and train in the gym and at home 3-5 days a week so the bit about the exercise failed to do anything except annoy me.
However, the part about the food was deeply troubling since I have been eating a diet close to the Mediterranean diet for decades. I cook whole food and my diet has always been high in fat and protein with complex carbohydrates like beans and lentils. However, I am guilty of eating white rice with asian food and potatoes with my meat but as a rule I don’t eat processed food or overt sugar.
I could not accept that I was prediabetic. I didn’t feel that I met the profile based on my diet and the fact that I exercise in the extreme so I immersed myself into the peer-reviewed literature—surely I would find an error there, something the doctors had missed or didn’t understand. I wanted to know unequivocally what the science had to say about this issue. So get ready for a wake up call.
Prediabetes is defined as blood glucose levels above normal but below levels considered diabetic (1). Normal fasting blood glucose is 65-99 mg/dL. The American Diabetes Association considers Impaired Fasting Glucose (IFG) in the range of 101-124 and hemoglobin A1C in the range of 5.7-6.4% as prediabetic (1; the numbers reported in this citation were converted from mmol/L to mg/dL using a conversion factor of 18 for the purpose of this publication and may vary somewhat from other publications; http://www.diabetes.org).
Over 50% of US adults over 65 years of age are prediabetic (2). Of the population designated as prediabetic there is a 5-10% conversion rate to Type II diabetes each year and 70% of us will eventually transition to full blown diabetes. In 2010 there were an estimated 79 million adults with prediabetes and approximately 81% are overweight and 19% are normal weight (1,2). Worldwide it is predicted that 472 million adults will be expressing prediabetes by 2030 which means that around 330 million people worldwide will transition to full blown diabetes in the coming decade (calculation based on 70% conversion factor from (2)).
I am not going to lie, these statistics put me on my ass. I looked up impaired fasting glucose (IFG) next because this cassette of characteristics is common in prediabetics. I expected to be relieved. I wanted to say, “See I don’t have any of those symptoms.”
The symptoms associated with IFG are listed below (3; https://en.wikipedia.org/wiki/Impaired_fasting_glucose):
Increased thirst
Increased urination—especially at night
Tiredness and fatigue
Blurred vision
Slow healing of wounds
Altered sensation—tingling, numbness of the hands
As I read the Wikipedia page my heart sank. I got up out of my chair, walked to the bathroom and stared at my reflection in the mirror. At various times over the last decade I had experienced the full list of symptoms published on the Wikipedia page.
Hot fear throbbed in my chest. I was truly afraid for my life. I was angry too. I prefer threats that are more overt like the ones you can see hurling at you in the mountains. This one, diabetes, was insidious and silent. A premonition of a future that could include (http://www.diabetes.org):
cardiovascular disease
nerve damage
kidney failure
eye damage
amputation—especially the feet
skin diseases
Alzheimers and depression
All of these complications are possible from Type II diabetes. To make matters worse the average annual medical costs incurred by a diabetic is around 13,700 dollars (2,4).
Yet as I stared into the eyes of my reflection I said, “There is no fucking way that I am going to be a diabetic.” After all, I had made a commitment to my wife to live to be 100 years old and I had no plans to do that as an invalid strapped to a bed with a tube down my throat, legs cut off below the knees, and hooked up to a dialysis machine.
I remembered that more than one person in my CrossFit gym had reversed full blown diabetes. This gave me hope and I turned away from the mirror and resolved to reverse my condition. The first thing I did was buy a blood glucose monitor to verify the doctors results. My fasting glucose was high between 98-110 mg/dL (blood glucose tested via Keto-Mojo Meter ). I wasn’t punching the fucking ceiling of high blood sugar but my fasting glucose wasn’t normal.
Secondly, I started working out twice a day, everyday—the literature was unanimous on this issue—that lifestyle modification composed of diet and exercise could stave off the transition to diabetes or reverse it (5). I committed to the CrossFit program in the morning at the gym, or at home, and then did sprints in the evening. I figured that I’d burn up all the excess sugar in my blood—this turns out not to be the case—more on this later.
Lastly, I went agro on my diet. No more potatoes or white rice and no more beer while I prepared dinner. I bought the finest whole grains, legumes, and beans that I could get—my grocery bill increased substantially. I doubled the size of our fruit bowls in the morning—they wanted a half a plate at every meal. I followed the Mediterranean diet to the letter (see above). Yet my fasting blood glucose was still high with spikes that caused me to panic. And the worst of it were the blood glucose spikes I saw after fruit, whole grains (farrow was the worst of them), and black beans were mind bending. I need to say that I actually measured out the farrow and black beans to stay within a single serving of carbohydrates prescribed by the Mediterranean diet.
After two weeks of this, on a Saturday, I became despondent. I questioned my own belief that my condition was reversible—maybe a diabetic future was unavoidable. I was nearly in tears when I went to the CrossFit gym for my afternoon workout. It was here that I spoke with the gym owner, Regan Doele, about what I was going through. After listening to me for a few minutes he shook his head, “Its the carbs, Pete.”
I opened my mouth to argue with him but he raised his hand and cut me off. “Take the carbohydrates out of your diet,” he said. “Go Ketogenic.” He gave me the link to a Ted Talk given by Dr. Sarah Hallberg (https://youtu.be/da1vvigy5tQ).
Later, after my workout, I watched the video and for the first time since getting my blood results back I felt like there was a way forward. That it was indeed possible to reverse prediabetes and that I might be able to see the beginning of normalized blood results in just a couple days—to good to be true? Keep reading.
I spent the rest of the day immersed in the literature and will draw the readers attention to Hallberg, S. et.al., (2018). Basically this non-randomized study shows that patients with full blown diabetes can reverse their condition by committing to a ketogenic diet (restricted carbohydrates). Dr. Hallberg is part of Virta Health and the details of the ketogenic diet and links to a wealth of peer-reviewed literature can be found at www.virtahealth.com. The bottom line is that I started the Keto diet later that Saturday on February 19, 2019 and within a few days my fasting blood glucose started to normalize: 2-21-19: 82 mg/dL, 2-23-19: 89 mg/dL, 2-24-19: 87 mg/dL.dL (direct blood measurements using Keto-Mojo Meter).
I also measure my blood glucose at one hour and two hours after meals. At one hour your blood glucose should be under 140 mg/dL and at two hours under 100 mg/dL. In all cases my one hour has been below 140 mg/dL and in a couple cases my two hour reading has been higher than 100 mg/dL but most of the time my two hour test is below 100 mg/dL.
Readings above 100 mg/dL at the two hour mark have been associated with higher protein intake which can raise blood glucose levels since glucose can be produced from the digestion of protein—the effect of protein on production of glucose is delayed as compared to eating carbohydrate so the blood glucose takes more time to peak. I have also seen consistent elevations in my blood glucose after workouts and sometimes I see increases that don’t make any sense such as higher fasting glucose when I did not ingest any carbohydrates the night before—often those higher values seem to correlate with poor sleep which has been reviewed in the literature (7)—but this is a speculation on my part.
The one thing that I can say unequivocally is that over the past month my average blood glucose has settled in around 90 mg/dL and I am anticipating that my next blood draw, which is coming up in two months, will show a moderate reversal of prediabetes. The Ketogenic diet coupled to exercise works to lower blood glucose and has additional benefits (www.virtahealth.com). If you have recently received a diagnosis of prediabetes or Type II diabetes and you are reading this because you are looking for a solution here is what has worked for me:
- Buy a blood-glucose monitor that can also measure ketones; I recommend https://keto-mojo.com. Test your fasting glucose in the morning when you awake and then after meals at one hour and then two hours. One hour should be less than 140 mg/dL and the two hour less than 100 mg/dL. Do this religiously before starting the Keto Diet so you know what your average glucose values are without any intervention.
- Obtain a log book and record your values including what you eat and drink, sleep patterns, exercise details, physiological issues like headaches and muscle cramps, lifestyle issues like long drives, restaurant adventures, etc. This way you will be able to see how specific foods and activities affect your glucose values which will allow you to make intelligent choices about how to change your lifestyle.
- Got to www.virtahealth.com and start the Keto Diet. To know whether or not you are in Ketosis you have to monitor your ketones (https://keto-mojo.com).
- If you don’t exercise, start right away. Walking the dog is NOT enough. You should be doing something everyday and for 2-3 days a week the movement should be intense. See crossfit.com. or other alternatives such as high intensity interval training (HIIT). If these options seem to be too much for you, then learn three or four fundamental compound movements (eg. air squat, burpee, snatch with kettle bell, jumping jacks, step-ups, push-ups) and then perform Tabata’s at least two or three days per week interspersed with the walking—you can do all of this at home with little or no expense. A single Tabata only takes about ten minutes of your time and can require little, if any gym equipment—maybe a kettle bell if you so desire.
If you follow the above guidelines you should see your blood glucose values begin to normalize relatively soon. In my case it took only a couple days to see a positive trend. The literature says that on the Keto diet that you can expect blood glucose normalization and reduction of A1C within 70 days (6).
Lastly, the reader should understand that under most health insurance policies there is little or no support for preventative strategies and the blood meters and their accessories were out of pocket expenses.
Additionally, the “standard of care” would keep you on a diet that has carbohydrates in it and is most likely the reason why there is a 70% conversion rate from prediabetes to full blown diabetes in the long run (1,2).
Watch my blog for the coming stream of articles that will focus on the intricacies of becoming diabetes free using the Keto diet and exercise.
Update: At 100 days my A1C is 5.2 and fasting glucose is 84. This is my second blood draw. I am no longer prediabetic. My first draw at 52 days involved an A1C paper test and an A1C conventional test. The paper test gave a reading of 4.8 and the conventional test gave 5.5. I think the paper test was less accurate. I am in reversal and no longer prediabetic on the ketogenic diet.
References
1. Tabak, A.G., 2012; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3891203/pdf/nihms535847.pdf
2. Tuso, P., 2014; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4116271/pdf/permj18_3p0088.pdf
3. https://en.wikipedia.org/wiki/Impaired_fasting_glucose
4. American Diabetes Association; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3609540/pdf/1033.pdf
5. Bansal, N. 2015; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4360422/pdf/WJD-6-296.pdf
6. Hallberg, S., et. Al. (2018); https://link.springer.com/article/10.1007/s13300-018-0373-9
7. Knutson, K. L., et. al. (2007); https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1991337/pdf/nihms25263.pdf
