Reversing Type 2 Diabetes – An Obesity M.D. Video

I ran into this video on YouTube (while looking for some music video to watch, go figure…) and found it well done. It is by an M.D. who runs an obesity clinic that also ends up dealing with a lot of diabetes. What she finds is basically what many folks have found: To reduce or eliminate your blood sugar issues, stop or strongly reduce your intake of carbohydrates (and especially ‘fast’ carbs like sugars that hit the blood stream in a fast spike).

Here’s the video, a TED Talk:

I helped my Florida Friend do something very much like this, but slightly modified. He had blood sugar readings in the low 200’s in the hospital (where they were feeding him mashed potatoes… go figure…). After he was out and having more salads, fritatas with vegetable fillings, “lump-o-meat” entrees, steamed vegetables; and only a very small portion of brown rice or potatoes: his blood sugar readings were normal.

For him, being only mildly on the problem side of things, “low not zero” carbs works. For folks who are clinically obese with significant insulin resistance (as described by the Dr. in the video) it is likely they do need to skip all GPS – Grains, Potatoes, Sugar. IMHO the “problems” show up once your carbs intake exceed your daily burn rate. IF you run marathons and bike to work and dig an acre of dirt each weekend gardening, then you can consume a lot more carbs before you have any left over at the end of the day to start that insulin ramp cycle. If, like me, you spend all day sitting in front of a computer / TV and occasionally walking to the kitchen to cook and eat; well, let’s just say my carb burn is likely met by two pieces of toast and a small potato in my evening stew… or the rice on my sushi.

Now realize that’s just my hypothesis, my guess. Based on nothing more than having observed when my own weight changes and how I do on different meal plans. YMMV, especially if you have insulin resistance in spades.

Why mention that at all? Because the good doctor lists as her point 5 to have no GPS – Grains, Potatoes, Sugar. I’m just pointing out that’s for clinically obese patients with strong type 2 diabetes and (as she states at the end talking about herself not needing that diet) it isn’t needed for “normal” folks. So I’m just suggesting that one can modulate the effect of carbs rather than taking a hard Yes/No binary decision.

So that’s my opinion on the one place where I have a trivial issue with the video. I’ve had no problems with small amounts of grains, especially really whole grains, and the occasional potato. I buy grains that are the actual grain in a bag. I don’t buy boxes of “whole grain donuts” or other strange-not-a-grain thing. The one exception is a whole wheat pasta. Yes, it is processed, but not like a mystery-box with 200 ingredients on the list one of which is “whole grain”. A small amount of whole wheat pasta with a cream sauce or pesto ought to be fine for someone with normal blood sugar readings from all the rest of their diet. Especially when it is basically just a side dish to a large dinner salad and pile of steamed vegetables with butter on them.

The fiber in whole grains slows the digestion and absorption of the starches and flattens the whole peak sugar compared to highly refined versions. That flattens the insulin spike and reduces the odds that the sugar digestion runs out while the insulin still has hours to go in the blood stream. That brings it inside the range most folks can handle. BUT, if you are outside that range and it does cause a blood sugar spike in the hour of digestion, then it’s not working out OK and needs to be abandoned. In my opinion, let your blood sugar readings be your guide to what works for you and what doesn’t. Not “some guy’s” opinion.

The Vegetarian POV

In contra-point, we have the vegetarian approach. In this video the Doctor spends a long time working up to the fact that his advocated diet is a vegetarian one. I know the vegetarian approach works due to a family “twin study”. The twin on the vegetarian diet is much thinner than the one eating lots of carbs & meat. But is it the meat, or the carbs? Unclear. IMHO, the vegan diet leads to other health issues (since it is nearly impossible to “do it right” so most folks eventually don’t bother tracking all their omega-3s and B vitamins and amino acid profiles and…)

I’d also complain that his examples showing we must be naturally vegetarians ignores the observation that Chimps also go hunting and eat a low meat diet, not a vegan one. Meat eating did NOT start with the stone age. It started millions of years ago at the Chimp level of advancement. Gorillas are obligate vegans and have a very long large gut to digest all that “roughage”. We have a much shorter gut suited to an omnivore diet. We likely have been scavengers and opportunistic meat eaters for all of human evolution. Do we now eat too much? Quite likely. But that does not mean zero is the answer. It means a nice side salad, some asparagus, and some buttered broccoli ought to dominate the plate with a petite steak; instead of a 2 lb. steak and 1 lb. potato and a quart of red wine…

In the video, the Dr. offers the mechanism that the cells fill up with fat globules and that causes insulin resistance (so far so good…) but then leaps to the conclusion that the answer is to stop eating fat. Not so good. Without the right fatty acid profile, you die. Clearly you MUST have some fat intake. This point is not addressed and I would guess the assumption is just that folks will not actually get to zero fat intake and “it will all work out, somehow”… I’m not fond of that degree of casual inattention.

IMHO, yes, fat build up in the places that burn sugar (like the muscle cells) is the mechanism for causing insulin resistance. BUT, that fat can come directly from dietary fats OR from excess carbs that are turned to fats in the liver et. al. It ought not to matter HOW the fats in the diet are reduced “enough”, only that it eventually happens. Then insulin resistance ought to end.

That “fat in the cell” one mechanism also ignores some minor points like that fats cause you to feel full and stop eating, and that starches and sugars give a big blood sugar spike that causes an insulin surge that causes more sugar-to-fat enzymes and conversion and results in more hunger and cravings. So the “entry” to the vegetarian diet needs to be done in such a way as to avoid sugar and carb spikes anyway.

OK, what’s the good bits? First, that getting total calories down via either reduction of fat intake or reduction of carbs intake leads to lower fat levels inside the cell leads to reversal of insulin resistance. Second, that all those lovely vegetables he shows in his picture are fine on either dietary approach. It is raising the non-starch vegetables that works well on both approaches. The only “argument” is over the meat/fat component vs the carbs component.

Now, once reversed, a lot of that blood sugar spike / insulin spike / fat formation & hunger cycle will be gone in either case. Then, having a vegetarian approach with more fiber loaded fruits and vegetables and not all that much starches and sugars will continue to be OK (especially as vegetarians tend to eat whole grain stuff and lots of fiber slowing the sugar absorption spike anyway). It is also darned near impossible to eat too many calories on a vegan diet (that eliminates all the milk, dairy, eggs allowed on ovo-lacto vegetarian diets). Unless you are drinking seed oils, there’s just too little calorie density in the foods.

Sidebar on Rice: Ever notice that a cup of dry rice makes about 2 quarts cooked, and of that you can eat about 4 ounces? Now think about that. That 4 ounce (volume) serving is about 1/16 of the dry rice cooked.

For those who are fraction-challenged due to a metric immersion and education: 4 cups / quart; so 8 cups in 2 quarts. 4 ounces is 1/2 cup. so 8 cups is 16 half cups. Thus that 4 ounce serving is 1/16 of a dry cup of rice. Or 1/2 ounce. Nearly nothing, really. Now it takes roughly one dry pound to feed a person for a day. Cook a pound of rice, you get somewhere near or over a gallon of cooked rice. Call it 4 liters. Think you can eat a liter of cooked rice 4 x a day? That’s why I don’t worry about folks overeating rice with a meal.

So, OK, eat a meal based on cooked whole grains and non-starchy vegetables without butter or cheese? Yeah, you will loose weight and blood sugar will drop. You also will not be very satisfied and will have some significant metabolic challenges to meet by being VERY careful with exactly what and how much you eat of some “odd” things to assure you do not develop several dietary disease issues. For example: Omega-3 Fatty Acids are essential to life. To get the ones you need on a vegan diet, you MUST include Flax (seed, meal, oil) or a supplement. It is naturally found in grasses, but people don’t eat grasses. Grazing animals do (and sea grasses are the source for fish, though it comes through some other animals first for most fishes). So unless you want to eat a bale of grass every day, you’ve got a problem best met by animals, fish, or animal products. Very few people actually add the flax meal to their diets even though they ought to.

So what’s my point? Damning with faint praise. Yes it will work, but he’s ignoring the other issues of managing a real full on vegan diet. (Vegetarian is ambiguous. It can mean “strict vegetarian” with the synonym vegan. It can mean ovo-lacto vegetarian that allows eggs and dairy. Allowing eggs and dairy makes being a vegetarian a whole lot easier to manage as their are several key vegan nutrient issues that “go away”). This doctor does not state if his use of Vegetarian means ovo-lacto vegetarian or vegan. That’s a warning sign. Similarly, he does not mention that doing vegan and having key nutrient issues to manage is a non-trivial task. You don’t just eat kale and rice and live a long time. So yes, it will work. But also “warning: some assembly required, intelligence needed, and meal planning critical with some background in nutrient biology and biochemistry.” With that said, here’s the other approach:

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About E.M.Smith

A technical managerial sort interested in things from Stonehenge to computer science. My present "hot buttons' are the mythology of Climate Change and ancient metrology; but things change...
This entry was posted in Biology Biochem, Food and tagged , , , , . Bookmark the permalink.

48 Responses to Reversing Type 2 Diabetes – An Obesity M.D. Video

  1. p.g.sharrow says:

    Question? does beer count as a carb or a whole food? . ;-) ….pg

  2. Sole Public says:

    Robert Lustig, MD and Peter Attia, MD, IMO, are even better. Both are practicing physicians and serious researchers (a prerequisite of mine – Ize a card-carrying research physiologist). Lustig, a neuroendocrinologist, explains how your hypothalamus becomes insulin resistant. Biochemistry leads behavior – your hypothalamus can’t receive information about your fuel stores, so puts in place energy conserving measures (commonly known as gluttony and sloth). Insulin resistance in the liver results in Metabolic Syndrome – which can be reversed in a couple of weeks even when eating junk food by replacing sugar with starch. Fructose (esp. in processed foods where gut absorbance isn’t buffered by insoluble fiber*), is processed in the liver like EtOH (alcohol); it leads to fatty liver, and ultimately to cirrhosis unless one of the other deadly sequelae gets you first (cancer, CV disease, dementia, pancreatitis, and the other alcoholic diseases). Both Lustig and Attia have eponymous websites. A good intro to them is the 2016 Credit Suisse panel “Eating dangerously” https://www.youtube.com/watch?v=nOUYjFNAuNQ. Short version – in a couple of weeks you can switch your body from demanding sugars/carbs every few hours to a fat-burning metabolic profile in which your fat stores are mobilized and you have high performance and little hunger. Eating fat when hungry helps the transition. BTW saturated fat is good, even the American Heart Association accepted that in 2010. With enough bacon, I can live without Cheetos. Trans-fats are double not good, due to their damaging metabolic intermediates.

    Good luck, all, with those physiology hacks.

    *fructose in fruit is OK unless you’re a fruitarian like Steve Jobs, then you have the same risks listed above.

  3. philjourdan says:

    Beer is a carb. Unfortunately.

  4. p.g.sharrow says:

    Hey Phil ! we can’t have that. Beer is a staple ! ;-) A necessity of life.
    The Puritans stopped on Plymouth Rock just to make beer! 8-) …pg

  5. poly says:

    View some of Dr Tim Noakes research and results on low carb diets.
    He has skin in the game – he is a diabetic himself.

  6. E.M.Smith says:

    Beer (ethanol) directly enters the Krebs Cycle (Citric Acid Cycle) as such is it neither a carb nor a non-carb. On entry, it prevents carbs from entering the start of the cycle (as it has busied the last half of the cycle so the front half is blocked up.) yet directly powering the Krebs cycle is also sugar, so it’s sort of like a half degraded sugar…

    IF you have methanol poisoning, ethanol is give to prevent the methanol being metabolized into a toxic product that kills your nerves (especially visual and auditory — blindness and deafness). So having some ethanol blocking up that same pathway to sugar can’t be all bad ;-)

    IF you are ever suffering from some severe lack of energy, remember that the Krebs Cycle is the fundamental energy (ATP) production process and that ethanol ( or a beer) directly drives that energy production process.

    Just Sayin’… it’s fuel in, go-juice ATP out…

  7. p.g.sharrow says:

    Fermented beverage and food storage in 13,000 y-old stone mortars at Raqefet Cave, Israel:
    Present oldest beer making evidence to date.
    https://www.sciencedirect.com/science/article/pii/S2352409X18303468
    Grain gathered not farmed. interesting, Beer or Bread, or both? …pg

  8. Clay Marley says:

    Here’s a very good talk from Dr. Peter Attia on how the current dietary guidelines came to be. For those of you following the global warming science, this will all sound too familiar. Weak studies, charismatic scientist, senate committee under pressure to produce something, precautionary principal, groupthink, special interests, and burying studies that are contrary to the dogma.

  9. Another Ian says:

    “Beer is a carb. Unfortunately.”

    Quote I saw recently

    “When I read about all the bad things of drinking I gave up reading”

  10. H.R. says:

    @Another Ian: I learned that one as, “My doctor told me that all that wine, women, and song was going to send me to an early grave, so I gave up singing.”

  11. corsair red says:

    My dad was diabetic, and my sister is. For two years now, I’ve made a serious effort to control my carbs intake by keeping things simple. Green and yellow vegetables, cabbage, carrots, onions, tomatoes and lima beans are acceptable. Reasonably sized servings of protein. Pepperridge Farm Oatmeal Bread. I do eat bacon cheese burgers with pepper jack cheese on an onion roll. No rice, no potatoes, no corn. No processed sugars. That one wasn’t really hard, although I have a sweet tooth that would kill five ordinary people. I just stopped eating them. I decided one day, no more Reese’s Peanut Butter Cups. I haven’t any had since. That was a year ago.

    Add in two days of fasting 24 hours each week, and five days a week of walking on the treadmill. I’m down from 195 to 170 lbs. 38 waist jeans to 34. Average glucose meter reading under 90.

    Is some of this wrong? Probably. It has worked, though.

    As for vegans in any form, they should go back to Vega.

    @ Sole Public:
    With enough bacon, I can live without anything else. Even Law and Order: Criminal Intent. I love Vincent D’Onofrio’s character.

  12. cdquarles says:

    EM’s correct. It is a bit more complicated because there is way more inbuilt variability than is generally recognized. Also, it isn’t just insulin, too. Also way overlooked is the rest of the peptide hormone family of which insulin is just one example. I forget now how many somatomedins there are. I seem to remember 6 variations.

    Muscle, though, burns fat most of the time. Muscle burns sugar when oxygen is the limiting factor. Sugar, either via gluconeogenesis, diet, or released from glycogen, gets used solely when energy is needed quickly, since the glycolysis part of the system isn’t as rate limited as the citric acid/coenzyme A/oxidative phosphorylation part.

    Flip side … if you want to have your vascular system make collateral vessels, tissue oxygen levels are key. Lactic acidosis in tissue triggers chemicals that induce small blood vessel formation. [That is one of the good effects of exercise, but as with everything biological, too much of a good thing is just as damaging as not enough.]

  13. llanfar says:

    This is a great talk about diets, how the response differs individually, and how important the microbiome is to that diet (measured by glucose response)… https://youtu.be/0z03xkwFbw4

  14. Larry Ledwick says:

    It all comes back to the SAID principle (Specific Adaptation to Imposed Demand), want better oxygen uptake – create oxygen demand deficit through intense exercise. Want better collateral circulation, create long term demand for work output. Minimum interval for training effects is about 12 minutes, (to increase aerobic fitness your high oxygen demand exercise must last at least 12 minutes). This does not mean you have to be sprinting for 12 minutes just working hard enough for the body to have a sustained oxygen deficit such as walking a bit too fast to carry on a conversation with out becoming winded.

    Ability to clear lactic acid build up is developed by repeatedly creating a slight excess of lactic acid in the tissue.

    Figure out what capability you want to improve and then create a deficit in that process that lasts a reasonable period of time (12 – 30 minutes), your body will begin to adapt after is sees the same stress more than 3 times in a few days.

    The first stress event the body says “Crap why is he doing that”
    second event ( crap – he’s doing it again!”
    third time (looks like this is going to be normal will have to adapt)

  15. Clay Marley says:

    Being diagnosed pre-diabetic, and with all the signs of metabolic syndrome, I started researching diet a couple of months ago. On 9/3 I started a low-carb high fat diet. On 9/14 I had my blood checked. After 11 days on this diet the changes were:

    A1C was 5.8, now 5.2, no longer in the pre-diabetic range;
    Trig was 265, now 106;
    Glucose was 111, now 82;
    VLDL was 53, now 21;
    Cholesterol was 156, now 136;
    TRIG/HDL ratio was 6.9, now 2.9;
    Not much change in HDL or LDL.

    So, I’m sold. If you have signs of metabolic syndrome, throw out most everything the ADA and other TLAs recommend, give low-carb high-fat a try. You may just get your life back.

  16. tom0mason says:

    Interesting stuff there EM. I believe you’re on the mark with comment on ‘fat build up in the places that burn sugar (like the muscle cells)..’ Fat build-up is what your body does with the excess — fat is made by your body.
    I’ve just had some blood tests and I’m apparently the wrong side of having too much iron in my system. Might be Haemochromatosis, apparently it’s quite common for Irish Celtic types to have.
    Oh well now for a change in diet, and as someone who dislikes modern tasteless, textureless, mush-meat called chicken, this might be a challenge.
    Out goes red meat and offal (my favorites), out with the normal multi-vitamins with minerals, lower the vitamin C levels, less fat; up the soya ‘meat’, eggs, and milk intake. Careful watch on sugar and starches as Haemochromatosis often leads to diabetes. Start a Mediterranean type diet maybe.
    Doctor seems a little confused as I’ve not drunk alcohol for many decades. Next-up come lots of scans and tests for liver function.
    I’ve found something online that may help — http://www.irondisorders.org/diet/. I wonder if anyone has any experience of this condition?

  17. cdquarles says:

    Again, the parts of the body that routinely ‘burn sugar’ are red blood cells (you don’t want your oxygen carrier using oxygen for energy) and nervous tissue. Nerve energy requirements are, at the cellular level, not particularly high, but need to be ‘fast acting’, because nerve action requires shuffling ions across semi-permeable membranes at all times. The rest of the body mostly burns fat at a relatively constant level. Glycolysis is relatively fast, but ‘bursty’, and lactic acid poisons it. Oxidative phosphorylation is ‘slow and steady’. Impairing oxygen flow poisons it. So, sugar, above immediate needs is locally converted to starch first (relatively fast) and fat later. All of this is modulated in real time by local chemical conditions and includes extracellular chemical signalling. The body mostly burns fat first and sugar in specific conditions. If you don’t get enough sugar, your body will ‘burn’ itself to make some.

    @tomomasion, Oh boy, hemochromatosis is horrible. The most efficient way to treat that is bloodletting. There are other ‘heavy metal’ hepatic conditions, too. Copper excess comes to mind. I don’t remember vitamin C levels being a factor … yet here is another example of the harm that can happen to some who take pharmaceutical doses of ‘supplements’.

  18. E.M.Smith says:

    @tom0mason:

    We Celts were made to survive bleeding…..

    Fish is low in iron….

    You can become a regular blood donor… or just pick bar fights a lot ;-) Maybe start attending Trump rallies or pass out Bibles outside a Mosque 8-}

  19. Larry Ledwick says:

    Or hang out in leech infested fishing holes. ;)

  20. tom0mason says:

    Yes EM there’s been mention of blood letting, seems all very 17 century to me.
    Fish is a favorite food of mine, may even take-up fishing again (if I can find the energy to do it). I used to fish a lot decades ago, mostly river fishing with some sea fishing when I could.

    @Larry Ledwick, I’ve always thought of leeches as utterly fascinating critters — lives spent on just a hope that a suitable meal will pass by. Now they are commandeered into doing good work by the medical men.

    @cdquarles the vitamin C’s ‘problem’ is it apparently helps the body extract iron from both Heme (haem?) and non-heme sources, as well as assisting the body’s natural ability to reuse iron from spent blood via a liver function.

    All this happened because of a routine blood sugar test showed a higher than normal (I’m usually quite low), and I was feeling persistently very tired and rundown. I hadn’t significantly changed my diet so other test ensued, leading to finding a higher than normal blood-iron count. So far I’ve had 19 blood tests, a stint of 24 hour heart monitoring, and a course of vitamin D and folic acid supplements. So now I’m awaiting the results of blood, heart, and a preliminary liver test (ultrasound). More tests are scheduled for later in the year.

    Well as they say ‘a change is as good as a rest’, so currently I welcome a change of diet to more fish, eggs, and turkey base and even more vegetables.

  21. Kneel says:

    Regular, short fasts do a great deal of good for those with type 2 diabetes – if it is just the “incipient” version, or if it has just started, a 12-16 hour fast every 2-3 days make a BIG difference.Not sure why, but I suspect it resets your insulin systems.

  22. H.R. says:

    1st the setup, then a question for the brain trust here.

    I’m Type II and have appreciated this thread very much. I have started to work 16-18 hour fasts into my routine. I’m down to about 100 grams of carbs per day in as complex a form as possible and have upped my fiber intake. The carbs are because my liver goes into high gear if I go with no carbs and my glucose reading is higher than with a bit of carbs spread through the day.

    Food Intake: Yesterday was breakfast at 10:30 am and was sausage and eggs. Mid-afternoon I had some pork rinds for a snack from the crunchy/salty food group. Dinner at 6:30 pm was a salad and a chicken leg quarter. The salad had a grated hard cheese and commercial chunky blue for dressing, so there was a bit of carbs there. No more eats after that.

    Activity: I went fishing last night, so I got a bit of exercise and this morning I ran errands, pooper scooped the property, and cleaned out the koi pond pump and filter. I’m always up and down letting out the dogs and then chasing them down to keep them from digging up the yard.

    It is 12:55 pm EST as I write this – still haven’t eaten as it is a fasting day – and I took my blood sugar at 12:30 pm. I was expecting 100-ish and it was 150! Oh… no usual high sugar feelings of numbness or tingling and no blah feeling.

    A) What the $@#! is going on?!? I think my liver is panicking, but I really have no clue.

    I’m feeling quite good right now and getting ready to run up to the County Fair for a few hours so Ill be walking around a fair amount. I plan to eat something meaty and it will involve a bun, but I’m skipping all the other carbs and sugars of the usual fair food.

    B) Just what in the Sam Hill does a fellow have to do to get a reset?

    I’ll be back this evening to see what (very) educated analysis is posted. Thanks in advance for your thoughts, y’all.

  23. Larry Ledwick says:

    Total fast or have you had small bits of food or drinks with carbohydrates in them (like sugared tea)?

    On one of the intermittent fasting web pages I was reading a while back an intake of as little as 50 grams (2 ounces) of carbohydrate can turn off some of the adaptations to fasting like higher fat metabolism.

    How about dehydration? are you not only fasting but taking no hydration?

  24. cdquarles says:

    Hmm, may be a somatomedin family issue. It definitely sounds like gluconeogenesis has been triggered, Mind you that both skeletal muscle and the liver are involved in the process. You might need to ‘eat like a bird’ and alternate that with only overnight fasts most of the time then try for a weekend fast monthly. Experimentation is required to find out what works for you.

    Reminder: there is a lot more in-built, within-group variability than is generally recognized; and that often exceeds the between-group variability.

  25. H.R. says:

    @Larry:
    When fasting, the last thing I eat is dinner, and I don’t do any sugary drinks or juices. I just do water or a flavored water (no sugar). But I may have to cut my carbs back to next-to-nothing if individuals can be that sensitive to carbs. Also, I think maybe I could do with an extra 16 or 32 ounces of water.

    Perhaps the spikes will go away when combined with cd’s suggestion.

    @cd: ” It definitely sounds like gluconeogenesis has been triggered”

    12-hour fasts are the norm for me. From the last thing I eat in the evening to the next thing I eat the following day, it would be rare to have less than 12 hours pass. 18-hour fasts are quite doable on a daily basis so I may look at that and cutting down on total caloric intake. Oh, my weight has been stable for about 4-5 years, so that says a little about my caloric intake.

    I do know that whenever I eat and regardless of what I eat, I zone out for an hour afterwards unless I immediately start some physical activity, but still I’m still fighting to remain alert.

    As mentioned upthread (by Larry?) I think maybe I’ll try to do two half-hour brisk walks per day, but I’ll have a bite to eat so my body doesn’t try to produce any sugar to keep my muscles going.

    Thanks again. I’ll decide on and make some diet and exercise changes pretty quickly. I’ll report back in a couple of weeks or perhaps a month or if some notable change in my blood glucose levels occurs. And if I make some input changes and observe no output changes, well that’s information, too.

  26. E.M.Smith says:

    OK, my guess would be that you are lipid saturated in muscle fibers and the liver is insulin resistant, so making sugars. (Why else would a near zero carbs intake cause a sugar spike … it isn’t going into the muscles or liver and the liver is responding to {something} with sugar production).

    One sidebar: Do you use any artificial sweetners? As noted before, just the taste of sweet seems to cause something to happen in sugar / fat metabolism… I’d dump the artificial sweetner for a couple of weeks and see if anything changes.

    So assuming your liver is stuck on insulin resistant, you might need to do a full on multi-day fast to reset it. Basically let it run the sugar production until it’s out of fat or reduced the fat levels enough to realize there’s an issue with using more and resets. Get to full on ketogenesis status. They sell “pee strips” that identify ketones in the urine to confirm you got there (part of the Atkins? diet kit IIRC).

    That’s the best guess I’ve got.

    Realize that many enzymes persist for hours to days in the blood. It takes me a full 2 weeks to get my inflammation markers down when I fall off the wagon and have too much beef and tomato stuff. Similarly, it can take a week or two to get them built up again when I start to indulge… Expecting even fast enzyme systems (like insulin) to respond in hours instead of days may be part of the problem… then realize that the insulin resistance cycle / active materials is NOT insulin, but some other receptors and enzymes… that react to insulin.

    Alternatively, you could try a major physical activity bump and get your “daily burn” of calories above your daily intake. That’s basically the same as a fast in terms of excess calories / day (i.e. negative).

    There’s also evidence that gut biota can have a big influence on overall metabolic chemistry, so you might want to try a cup of yogurt with live bacteria in it, or some acidophilus pills to get that set right. Every so often I get a “browned out and gassy” problem. When that happens, a bit of yogurt “up the wrong way” sets things right within 24 hours.

    That’s all I’ve got for ideas ATM.

  27. Larry Ledwick says:

    The other idea might be what sort of exercise do you get. During light exercise like walking with no oxygen demand, the body gets most of its energy from fats. Only the brain and blood cells depends on glucose as a primary fuel.

    However during exercise which is intense enough to get you winded your body burns more sugars and muscle glycogen for energy because it is a more time efficient process.

    For example when sprinting your muscles use mostly sugar/carb based energy.

    Do you do any activity that would make you work hard enough to elevate your breathing rate a bit.

    I go for brisk walks (30 minutes) and seek out hills to get to that state where you could not quite carry on a conversation or sing a song while walking (that is a common bench mark to know when you have switched from totallly aerobic exercise to slightly anareobic exercise.

    Since I work in IT and spend most of the day sitting watching computers I also have some dumbbells here at home and at work and when feeling a bit dull will pick up 2 dumbells which weight 20# each and do 25-35 half squats in place at my desk. That is a non-impact exercise you can do without even leaving your home that only requires a couple minutes and about 3-4 square feet of floor space. When working late it is a great way to wake myself up without using caffeine etc.

    You might see if a short interval of anaerobic exercise like that will pull down your blood sugar levels.

  28. H.R. says:

    @E.M.: Well, the brain trust here has given me some stuff to try. I suppose a 2-3 day fast is doable. I don’t have any problem with the 18 hours I was discussing, so stretching it out longer is worth a try.

    I do use artificial sweeteners. I’ve switched to bottled water starting about 9-10 months ago (danger of critters spilling my drink if I use a glass). About 1/2 the time I use the flavor-straw packets that are sized and shaped to dump into a bottle of water. I just checked on and the sweetener is aspartme.

    Surprise! I just also noticed that there are some fruit solids in those packets. I would have guessed that the the closest thing to fruit in one of those packets was if one of the packaging machine operators had an orange in their lunch sack. It seems they toss in a little bit of dehydrated powdered actual fruit that it is purported to be mimicking.

    So, yeah, no biggie to just go all water and cut out the sweeteners over the next few weeks and see what happens.

    Confounding factor: my liver, blood glucose levels, and beer.

    I do not drink alcohol daily and not even weekly. I do notice that when I’ve had alcohol the night before, my blood sugar levels are lower. I looked around a little on line and what I came up with is that the liver goes to into alcohol processing mode and stops producing sugar. One reference pointed out that, besides the ruination of the liver from too much alcohol, some diabetics actually wind up with dangerously low blood sugar levels to the point of it being a medical emergency if they drink too much alcohol while eating their low carb, low sugar diet.

    Anyhow, it’s college football season and my custom is to drink beer ale while watching ‘my team.’ So I suppose I’ll have an opportunity to try a couple of dry games vs wet games over the next month.

  29. H.R. says:

    @Larry: I used to walk a lot in my job(s) as a manufacturing engineer. I’d often be away from my desk and walking, making fixtures, climbing to the roof (facilities responsibilities), wrassling recalcitrant machinery, troubleshooting here and there (it never stops) and whatnot for 90% of my day. It truly was a rare day when I’d be riding my desk for more than 50% of my day. But… all that activity rarely got aerobic.

    I walk pretty fast when I walk, about 4 mph, but it doesn’t get aerobic. I stride and glide. I’ll see if I can bump up my exercise to at least a 1/2 hour a day of moderately aerobic activity.

    You make a good point about the aerobic aspects of the sugar burning equation.

  30. Larry Ledwick says:

    If you want to get into a bit of aerobic exercise to see how it effects your blood sugar and general fitness I strongly recommend you pickup a copy of Dr. Cooper’s New Aerobics book The old 1970’s edition, very cheap and goes into great detail about his method and the results.

    https://www.amazon.com/New-Aerobics-Dr-Kenneth-Cooper/dp/0552646679/ref=sr_1_2

    One note I reverse engineered the charts a couple decades ago and the points awarded are for the slowest time in the increment for each set of points. I worked out the exact exponential equation so you can work up your true points for exercise intervals that fall in the middle of the time segments he lists in his charts or you can come close with linear interpolation between the slow time and the fast time and the points awarded for that increment and the next highest if you are like me and not happy with almost but not quite accurate systems.

    His goal is to earn 30 points per week, and many first world syndromes of inactivity get diminished or eliminated. Minimum effective time period is 12 minutes at an aerobic pace. Most time effective exercise interval is 30 minutes, although at very low pace levels duration has a value of its own.

    Exercise periods longer than 12 minutes are more or less additive so if you don’t have time for 30 minutes of exercise, but can do two intervals of 15 minutes you almost have the same training effect.

  31. H.R. says:

    Re New Aerobics;

    I’ll get a copy Larry. I like the idea of a points system. Once you learn how to ‘score’ points, then it’s easier to set goals and to log points. We keep a fair-sized calendar on the pantry door and it would be easy to just write down the points; 3, 7, 10, whatever. It would be very quick to check where you are and where you need to be for the week.

    I am fairly active, but typically not aerobic. I’m assuming there are suggestions in that book that would allow me to turn some of my typical activities into aerobic activities.

  32. Larry Ledwick says:

    Yes he has charts for all sorts of common exercises. This PDF is a direct extract from the book although you miss out on the descriptive part of the book of how the system came about.

    https://www.cooperaerobics.com/Downloads/About/Aerobics-Points-System.aspx

    That is exactly why it was set up as a points system. He developed it in the Airforce so airmen could have a concrete metric to measure their progress and fitness.

    He started them off with a 12 minute test (how far can you go in 12 minutes running walking jogging you choice), that put them in basic fitness categories then depending on what catagory they were in he described an incremental program to build up to 30 minutes a week.

    He discribes how the body adapts to exercise gives cautions on how to do it and the obligatory if over 40 talk to your doctor etc. But his system is the basis for all the military services fitness qualification runs which they introduced in the 1980’s

    To be considered fit enough to be in the military you had to complete a timed run every year to prove you had maintained adequate fitness. Miss the goal too many times and you got discharged.

    https://cooperaerobics.wordpress.com/2013/03/18/fitness-testing-the-12-minute-cooper-test/
    https://www.cooperinstitute.org/2018/06/08/50-years-of-the-cooper-12-minute-run

    https://www.verywellfit.com/fitness-test-for-endurance-12-minute-run-3120264

    Right now I am earning about 15 -17 points a week as i am working my way back into better shape.

    I walk about 2 miles a day at work in close to 40 minutes in my normal street clothes, and do that 5-6 times a week with occasional mountain hikes on the weekend. Given I am at 5,00 -6,000 ft altitude that gives me about 2 points and change a day when I take my lunch or before work walks.
    At home I take the walks with a 25# pack. I am intentionally going very slowly in my progression because I am 69 years old so letting my body tell me when it is ready for more exertion. I am finally getting to the point now that I can run a few hundred yards several times during the loop without being a cripple the next day but I know from experience that if I go too fast and piss of my right knee it will set me back 2-3 months before I can get back to vigorous walking again. That is also one of the reasons I am doing the half squats to tighten up the muscles that stabilize the knee to prevent that happening.

    In the early 1980’s I could run (if pushing) 2.4 miles at a 7:24 pace at 5500 ft altitude. Which works out to 12-14 points for each run around the lake I did my loops on.

  33. H.R. says:

    @Larry: I’m glad you brought up the half squats. More than the walking, I’m not getting all the squatting, lifting, and wrenching activities that I was getting at work. I’ll need to add in some exercises that put some strength back into my muscles. Just walking isn’t going to cut it for me.

    By chance, I have a bum left knee, too. Fortunately, stairs don’t set it off and stairs have always been one of my favorite ways to work all of the leg muscles. It’s also very easy to get aerobic without running while doing stairs. The dam of the reservoir next door is about a 5-6 minute drive from the house, and that includes parking. It has steps from the base to the top. I think I’ll add in several trips up and down those steps as part of my routine.

    I would not have thought of stairs if you hadn’t been kicking around what you are working on for your own routine. I am beginning to form a plan.

  34. Larry Ledwick says:

    Okay just for grins I did a low tech 12 minute test. I live at about 5800 ft and this test was run at an average altitude of 5810, I covered 1600 meters in 12 minutes on an out and back more or less level walking path.

    Altitude correction is about +4% for this altitude so that puts me squarely just inside the normal fitness catagory for over age 50 (actual age 69), with an approximate VO2 Max of 24.5 (ml/kg/min) which given this was done in full street cloths not running gear and I did not push to absolute max (I ran and walked near max, but since I did not know exactly where I was, I did not completely wreck myself as I would have done on a military fitness run 30 years ago)

    I am happy with that result for a first test. I now have a benchmark to work against and beat and can slowly work my way into the higher levels of fitness without risking a complete break down or worse.

    For the high age group VO2 max info I am using :
    http://www.runnersblueprint.com/vo2-max/

    And using the cooper equation to estimate VO2 Max
    VO₂ Max = (Distance covered in meters during 12 minutes – 504.9) /44.73

    See also:
    https://en.wikipedia.org/wiki/VO2_max

    http://www.thefitmap.co.uk/exercise/tests/advanced/aerobic/cooper.htm

    https://www.cooperaerobics.com/Downloads/About/Aerobics-Points-System.aspx

    Enjoy!

  35. E.M.Smith says:

    FWIW, in karate class, we had exercises that put us in a mild aerobic state (prior to doing the actual karate training as ‘warm up’) and it was simple exercises. Jumping jacks. push-ups. sit ups, both sides side sit ups, etc. Let me tell you, doing 60 sit ups gets you breathing…

    You can easily reach a mild aerobic level of exercise without any knee involvement. Yeah, the squats and quads stuff is a biggy, but whole core side sit ups are no piker… Even just standing in a “low stance” for a while gets a quad burn going. Legs about 1/2 bent and arms held in boxing position. Do that for 3 or 5 minutes and you feel it in the legs and arms. Zero impact and knees not going to full flex. Then go do 20 pullups… and then 30 situps…

  36. H.R. says:

    @Larry: I went to the dam today and yup, stairs really get you aerobic in a hurry 😁

    Oddly, when I got to the top, I started walking the dam at a pace that I didn’t see being matched by anyone else. It actually cooled me down; heart slowed and breathing returned to normal. Plain walking is good, but it seems that I need steps or an incline to really elevate my breathing and heart rate.

    Anyhow, today’s ‘baseline’ for me was one set of the steps and about a mile and a half walking. (I’ll have to do a count of the steps and the rise in elevation in the next day or so.)

    I’m going to do one set of steps for the next few days and then bump it up to two sets and so on. The bonus is that I can look for fish in the spillway, so that keeps the boredom out of exercising.

    Oh. The steps didn’t bother my knee at all. I strained the portside, aft ligament on my leg a few years ago and it really hasn’t healed. So long as there is no lateral or torsional movement to my knee, everything is just peachy.

    I still haven’t decided on what to do for the upper body. I think I have some 1 lb wrist weights lying around somewhere and I’d like to add some weighted arm movements in while I’m walking. It should be easy enough to work the arms and chest while walking. I may have to make my own weights because 1 lb doesn’t seem like it will help much. I would want something closer to 10 lbs.

    Hmmm… maybe a weighted backpack would work the abdomen. Lean forward and straighten back up while walking…. or I could just carry my bowling ball on my walks. 😜

  37. H.R. says:

    Update: I stopped in Half-Price Books yesterday (9/23) to see if they had Dr. Cooper’s “New Aerobics”. No luck, but they did have a newer edition under a different title. I’ve got several things going on this week, so it will take several days to make it through the book. (Thanks, Larry. I think it is all you said it would be.)

    I also picked up a set of 2.5 lb each wrist weights. I really, really didn’t want to carry dumbbells around, although now that I think about it, they would be one of those ‘weapons at hand’ should the need arise 😎

    I counted the steps at the dam and there are 116 @ 6″ height so that’s a 58′ rise. Not bad. Also there’s about a 100 yard slope from the parking lot to the steps which I estimated as about a 30′ rise. That’s a nice little uphill warmup.

    Turns out, there’s a couple of info signs at the top of the dam that I hadn’t noticed before. The dam was listed as 90 feet high so my guesstimates were pretty much dead on.

    The drastic reduction in carbs, the switch to 18 hour fasts, and the steps plus walking have dropped my blood sugar readings from the mid-130s down to 110+/- and my best has been a 96.

    The advice and suggestions y’all have given have been working, and I will be tightening up my discipline a notch at a time as I work towards a goal of readings in the 80s and an A1C of under 5%. That would get me kicked out of the Type II club.

    Oh, one of my other goals is to get to the point where I can try a batch of p.g.’s oatmeal cookies. 😁 I am the original cookie monster and cookies are the one item that I cut out pretty much immediately upon be told I was Type II. (Uh… p.g. indicates that it might be hard to consume them in moderation, but by the time I get to the point of having a cookie here and there, I should be disciplined enough to handle it 😜)

    So, good news early and I’ll give it 3-4 weeks for another update.

  38. Larry Ledwick says:

    That is great to hear! Glad you are finding those suggestions useful.

  39. Larry Geiger says:

    Potatoes, peas and bananas. And I don’t like bananas. Must have more potassium. I’m often low on potassium and that affects my heart and the Myeloma. Potassium supplements don’t seem to work. My doctor told me to eat more french fries. Go figure. I do not seem to have diabetic issues. I eat salads but not a lot of fruit. Probably too much carbs but I’ve been cutting down on sugar. Have lost a few pounds.

  40. E.M.Smith says:

    @H.R.:

    Way to go, guy!

    Glad for you, and that in some way the collective here could be of some benefit!

    @Larry:

    KCl is sold in shaker tubs as “no salt”… We use the 50-50% mix of NaCl and KCl called “low salt”
    Seems to fix low K as KCl is very soluble…

  41. hubersn says:

    I was in hospital around a year ago where – apart from the real problem – also diabetes type 2 was diagnosed. Blood sugar levels of 250 to 300 mg/dl in the morning before breakfast, HbA1c of 11%. So a review of my lifestyle was necessary. I thought hard on how to change everything in a way that can be sustained for the rest of my life.

    I settled on a fairly-low-carb-high-proteine diet. I measured the response of my blood sugar levels for everything I eat. It turned out that whole-grain pasta is not a problem if kept under 80g per meal. Also, rice and potatoes were not really problematic if the serving was small enough. I switched some meals from meat to fish. It turned out that a lot of fruit I was regularly consuming did bad things to blood sugar levels, so I traded fruit against vegetables and salad. I changed breakfast from honey and jam to joghurt-based cream cheese and and ham (and lately Xylit-sweetened jam), always with whole-grain bread. As a small snack between lunch and dinner, I eat various nuts along with the one-apple-a-day

    I reduced calory intake from beverage to 0 – only water, diet Coke (yes, Aspartam is doing just fine!) and unsweetened black and green tea. I never drank alcohol, so nothing to reduce here. Which was real luck, because the first-line-of-defense medicament for diabetes is Metformin, which does not very well in conjunction with alcohol.

    I started some light activity of around 30min of fast walking after lunch along with a bit of swimming once a week.

    After a year following that plan, I have lost 35kg of bodyweight (nearly everything in fat, if my body analysis scale is anything to go by), the blood sugar level in the morning is below 100 mg/dl and HbA1c is now at 5.6%. So no longer considered a diabetic.I no longer have to take Metformin.

    I you are able to read German, you can read a few of my blog entries regarding weight reduction and diet. It worked for me. No idea if it will work for anyone else.

  42. Larry Ledwick says:

    Very interesting that “healthy fruit” was one of the proximate causes of high blood sugar and that complex carbs were not an issue if a small enough portion was used.

    All the health food folks seem to forget that fruits had (gasp) fructose, and can be a significant source of sugars if they are a major component of their diet.

  43. hubersn says:

    Results with different fruits were mixed. Apples are OK. Strawberrys, Raspberrys are OK-ish. Bananas are extremely bad. Melons are extremely bad. Oranges are bad. Grapefruits are OK-ish. Grapes are very bad. But vegetables and salad is just so much better (as long as you don’t use the wrong dressing for your salad! Avoid balsamico vinegar!) than most fruits for your blood sugar. And also to reduce calory intake.

    The good thing about diabetes is that you can so easily measure your blood sugar. So you can easily try out what works and what doesn’t work. At least for diabetes type 2 where your insuline production is still OK-ish. You can control what you can measure. If you are really serious, there are now continuous glucose monitoring devices – quite expensive, but also very valuable to find out what really happens inside your body.

    By the way, everything I did was based on information given by a nutrition expert in hospital. She was really really worth her money! Compared to much esoteric and non-logical advice I read on the Internet later…

  44. E.M.Smith says:

    @Hubersn:

    Thanks for the input!

    Ich verstehe ein wenig Deutsch, aber nur eine Klasse, also wer weiß!
    Ich mag die Idee eines mehrsprachigen Blogs, aber die Leute scheinen sich immer auf Englisch zu einigen. Naja…

    @Larry:

    My thesis (which I call “My Thesis” ;-) is that fructose is a normal signal that it is fall, and winter is coming, so eat all the fruit you can and add all the pounds you can as soon you will face 6 months of nothing to eat at all!

    To me, it is perfectly reasonable think evolution would favor those who “pork up” in fall and then go to ketosis in spring until crops come in and hunting is better.

    IMHO, the present “obesity epidemic” is just the result of us making it a perpetual dietary fall…

  45. H.R. says:

    hubersn: “The good thing about diabetes is that you can so easily measure your blood sugar. So you can easily try out what works and what doesn’t work. “

    I was just testing in the morning until what I was doing quit working. I didn’t know why, so I asked for help here and got lots of possibles and suggestions.

    While I’m working it out as to what it is that I’m responding to, negatively or positively, I’ve been testing 5-7 times per day. My fingers are starting to toughen up from all that stabbing and I’m on the deepest setting of the lancet device. That continuous monitoring device sure would be great to have! Maybe they rent them out.

    Fruit gets me too, but for some odd reason, potatoes seem to be my friendliest carbohydrate, behind whole grain products which is best.I don’t know why that is.

    I like that you point out that aspartame has no noticeable effect on you. I just cut aspartame out last week and switched to black coffee or water. I don’t know yet if aspartame affects me or not. It would be nice to have it as a sweetener, but none for me until I find out.

  46. hubersn says:

    If you don’t want to completely forget about the sweet stuff, I recommend trying several different sugar “replacements” like Erythrithol or Xylitol or Maltitol. For baking cakes, I settled on an Erythrithol-Stevia mixture which can be used as a 1:1 replacement for sugar (Erythrithol on its own sweetens a bit less than sugar per gram, about 50-70% depending on who you ask) and which tastes a lot better than pre Stevia which I don’t like at all.

    Erythrithol is basically zero calory and apparently tooth-friendly and has no effect on blood sugar level. I know some people use it to sweeten their coffee.

    For my beloved raspberry jam, I use Xylitol-sweetened stuff with 70% fruit. There is very few jam sweetened with Erythrithol out there, possibly because it does not gelatinize well.

  47. H.R. says:

    “[…] like Erythrithol or Xylitol or Maltitol.”

    Thanks for the tip! Other than Stevia, I hadn’t heard of the other three.

  48. Great post on diabetes. I have been trying to control my diabetes for almost a year now with yoga and meditation naturally. I must say it has really done wonders. I have jotted down the same for your readers, if it helps – https://ashmayuyoga.com/diet/how-to-treat-diabetes-naturally/ do check it out.

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