Christmas Status Letter

Reflections

Holidays provide time to reflect on the past year. It’s long overdue to circle back to the purpose of this BLOG. I started this journey of hacking my Type 2 Diabetes almost 18 months ago. In that time, I fixed my Diabetes and so much more.

No More Insulin or Medications

I am on ZERO medications. No diabetes medications. No hypertension medications. I still use a CPAP machine since I am afraid of quitting the machine.

Weight Loss

I have lost over 100 lbs. My starting weight was around 285 and it was 178 this morning. I’ve been in maintenance for a month now and my weight has stayed steady. I wish I had charted better in the beginning.

Added Exercise

After I lost most of my weight (around 80 lbs) I added exercise. I have been doing CrossFit for about four months now. I can lift weights that match the girl’s weights. I usually finish the Workout of the Day (WOD) last but I do finish – even the hard ones. I workout five days a week. The typical CrossFit workout is less than one hour. I take rest days Thursday and Sunday.

Blood Sugar Control

My blood sugar after working out last night was 65 (US units) which is really good. I most often see numbers in the mid 80s. My last HbA1C was taken this summer (before CrossFit) and it was 5.8 (which is at the bottom end of the prediabetes range).

My Macros

My diet consists largely of chicken, nuts and broccoli.

Chicken is a good Protein and different cuts provide different amounts of fat. Kim Chee (from Walmart refrigerated veggie section) is a good probiotic (good for stomach biome). Broccoli is a good veggie and easy to heat in a microwave bag. Finally, nuts fill in the fat numbers in a healthy way.

My Macros

My daily macros are:

My current macros are 1800 calories with 125g of Protein, 20g of Carbohydrates and 136g of Fat. Protein is a minimum. Carbs are a maximum. Fat fills up the remaining calories to meet the limit. If I go over on Protein I will go under on Fat to match. In percentages of daily calories this is 27% Protein, 5% Carbohydrates, and 68% fat.

Supplements

Here is what I take daily.

Breaking Stalls

I had a long stall this year which lasted for maybe six months. I did some extended fasts which helped a little bit. I then tripped across the idea of doing Protein Sparing Modified Fasting. That broke the fast and gave me a way to make progress with the last 25 lbs that I needed to lose.

My Goals

My goals have shifted over the past 18 months. They started with hacking my Diabetes. I wanted to get off Insulin. That took two weeks.

Since then I have worked at improving my Insulin Sensitivity. For me, the main tool was Intermittent Fasting (IF). One thing that interferes with this is getting in enough Protein. I have added a Protein meal at lunch time. This hasn’t hurt my Blood Sugar numbers.

Another way of improving Insulin Sensitivity is High Intensity Training. I do CrossFit. Training with increasingly heavier weights and intensity will improve Insulin Sensitivity. I hope to keep up this training and there are plenty of goals to reach. I got my first box jump and pullup in the past month.

 

Intermittent Fasting – The Science (pt 2)

Here is another study (Glucose Tolerance and Skeletal Muscle Gene Expression in Response to Alternate Day Fasting).

Method:

Glucose and insulin responses to a standard meal were tested in nonobese subjects (eight men and eight women; BMI, 20 to 30 kg/m2) at baseline and after 22 days of alternate day fasting (36 hour fast). Muscle biopsies were obtained from a subset of subjects (n = 11) at baseline and on day 21 (12-hour fast).

The results were:

Glucose response to a meal was slightly impaired in women after 3 weeks of treatment (p < 0.01), but insulin response was unchanged. However, men had no change in glucose response and a significant reduction in insulin response (p < 0.03).

Some significant results:

The protocol was well tolerated, weight loss was 2.5% of initial body weight, resting metabolic rate was unchanged, and fat oxidation, as measured by the respiratory quotient, was increased.

Subjects with type 2 diabetes were excluded.

The insulin response to a meal was not influenced by alternate day fasting in women but was reduced in men (area under the curve: 207 ± 38 to 130 ± 15, p < 0.03; Figure 1B), suggesting improved insulin sensitivity.

Also,

Furthermore, the insulin response to the meal was improved in men, suggesting that insulin sensitivity may be increased and not decreased after alternate day fasting.

 

 

Bible Fasting

Some verses to ponder on fasting:

Fasting

Est 4:16

Go, gather together all the Jews that are present in Shushan, and fast ye for me, and neither eat nor drink three days, night or day: I also and my maidens will fast likewise

 

2Ch 20:3

And Jehoshaphat feared, and set himself to seek the LORD, and proclaimed a fast throughout all Judah.

 

Mar 2:20

But the days will come, when the bridegroom shall be taken away from them, and then shall they fast in those days.

 

Joel 2:12
Therefore also now, saith the LORD, turn ye even to me with all your heart, and with fasting, and with weeping, and with mourning:

 

Act 27:33

And while the day was coming on, Paul besought them all to take meat, saying, This day is the fourteenth day that ye have tarried and continued fasting, having taken nothing.

 

How Much Glycogen Stores in Low Carb?

It’s often claimed that Glycogen stores are reduced in Low Carb diets. I wondered by just how much and there’s a paper out there which has specific numbers in it (Scandinavian Journal of Clinical and Laboratory Investigation Volume 32, 1973 – Issue 4. Pages 325-330. Liver Glycogen in Man –- the Effect of Total Starvation or a Carbohydrate-Poor Diet Followed by Carbohydrate Refeeding. Depts. of Gastroenterology and Clinical Chemistry, L. Hson Nilsson & E. Hultman, S:t Eriks Sjukhus, Stockholm, Sweden & E. Hultman).

Liver glycogen content was determined in specimens obtained by repeated percutaneous biopsies during starvation and under various dietary conditions in 19 human subjects. During rest and following an overnight fast, there was a decrease in liver glycogen content by a mean of 0.30 mmol glucosyl units per kg wet liver tissue per min during a further 4 hours’ starvation. Prolonged starvation or carbohydrate-poor normocaloric diet decreased the liver glycogen from a mean of 232 to 24–55 mmol glucosyl units per kg within 24 hours. During an additional period of up to 9 days on the carbohydrate-poor diet the liver glycogen remained at a low level. Refeeding with a carbohydrate-rich diet gave a rapid increase of the liver glycogen to supernormal values, 424–624 mmol glucosyl units per kg wet liver tissue.

Wow! That’s a pretty dramatic drop in liver glycogen in just 24 hours.

Glycogen Refill

Maybe even more amazing is the very fast refill to 2x-3x the “normal” levels. That goes a long way to explaining weight gain when leaving the Low Carb diet.

As a reference on the liver (Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition.Chapter 94 Evaluation of the Size, Shape, and Consistency of the Liver. Douglas C. Wolf.)

The liver weighs 1200 to 1400 g in the adult woman and 1400 to 1500 g in the adult man.

According to this article:

Liver glycogen provides about 400 calories or 100 grams of glycogen

If there’s 3-4 grams of water with every gram of glycogen that’s a total of 400-500 grams that are lost with reduction in glycogen. That’s less than 1 lb but a significant portion of a typical liver size (around 1/3 of the size).

 

How Much Muscle is there in a Person?

Bayesian Bodybuilding (How can you gain muscle while losing fat & more) cites an interesting study of muscle composition (Am J Clin Nutr. 1982 Jul;36(1):131-42. Biochemical composition of muscle in normal and semistarved human subjects: relevance to anthropometric measurements. Heymsfield SB, Stevens V, Noel R, McManus C, Smith J, Nixon D.). In this paper they dissected dead bodies to determine their body composition. Of particular interest was the Protein composition and water during semi-starvation.

 

What if the History of Diabetes Went Wrong?

In an interesting paper the question is asked what if the history of the development of our understanding of diabetes has it wrong? The paper (J. Denis McGarry. What If Minkowski Had Been Ageusic? An Alternative Angle on Diabetes. Science, Vol. 258, No. 5083 (Oct. 30, 1992), pp. 766-770).

Despite decades of intensive investigation, the basic pathophysiological mechanisms responsible for the metabolic derangements associated with diabetes mellitus have remained elusive. Explored here is the possibility that traditional concepts in this area might have carried the wrong emphasis. It is suggested that the phenomena of insulin resistance
and hyperglycemia might be more readily understood if viewed in the context of underlying abnormalities of lipid metabolism.
Some powerful food for thought in the paper. Another paper (Arius, Energy Metabolism) summarizes the argument as:
The author considers the possibility that the hyperinsulinemia of early non-insulin—dependent diabetes is coincident with hyperamylinemia, since insulin and amylin are cosecreted. Amylin would cause an increase in plasma lactate (Cori cycle); and lactate, a better precursor than glucose for fatty acid synthesis, would indirectly promote the production of very-low-density lipoproteins (VLDL). There would follow an increased flux of triglycerides from liver to muscle (and adipose tissue) and, as proposed and elaborated on, an increase in insulin resistance and production of many of the metabolic disturbances occurring in diabetes.
 The author of the paper draws heavily on the Randle Cycle.
The Randle cycle is a biochemical mechanism involving the competition between glucose and fatty acids for their oxidation and uptake in muscle and adipose tissue. The cycle controls fuel selection and adapts the substrate supply and demand in normal tissues. This cycle adds a nutrient-mediated fine tuning on top of the more coarse hormonal control on fuel metabolism. This adaptation to nutrient availability applies to the interaction between adipose tissue and muscle. Hormones that control adipose tissue lipolysis affect circulating concentrations of fatty acids, these in turn control the fuel selection in muscle. Mechanisms involved in the Randle Cycle include allosteric control, reversible phosphorylation and the expression of key enzymes.[5] The energy balance from meals composed of differing macronutrient composition is identical, but the glucose and fat balances that contribute to the overall energy balance change reciprocally with meal composition.
Interesting thoughts.
Fatty acids may act directly upon the pancreatic β-cell to regulate glucose-stimulated insulin secretion. This effect is biphasic. Initially fatty acids potentiate the effects of glucose. After prolonged exposure to high fatty acid concentrations this changes to an inhibition.[13] Randle suggested that the term fatty acid syndrome would be appropriate to apply to the biochemical syndrome resulting from the high concentration of fatty acids and the relationship to abnormalities of carbohydrate metabolism, including starvation, diabetes and Cushing’s syndrome.
My own weight had been in the 280 range for a long time. In the months before I was diagnosed as Type 2 Diabetic my weight dropped 50 lbs without any lifestyle changes. After I went on Metformin my weight was relatively lower for a while. When I eventually went on Insulin my weight went up 40+ lbs fairly quickly. It is well known that Insulin adds weight.
My own thought is that the Insulin is both the lock and the key. Increased levels of Insulin pushes glucose or fat into cells and decreased levels of Insulin allows fat to come out of cells. That’s why Intermittent Fasting is such a great bullet for Type 2 diabetics. It allows our fasting Insulin levels to drop. Add to that Low Carbohydrate diets and the perfect recipe for controlling Diabetes comes into play.
The problem never really was Insufficient Insulin. The problem was too much Insulin. And clearly it is a fat related problem.

mPSMF – Weight Loss Progress

My modified Protein Sparing Modified Fast is moving along very well. Here’s my weight loss chart (from Cron-o-meter):

I had a nice drop over the past couple of days. Note that I started teh food diary in Cron-o-meter on Oct 24th. That may contribute to the losses due to the increased attention to intake. Before that I was using my own spreadsheet to track diet.  Cron-o-meter may be making me more accurate with measuring food intakes.

Goals Changes?

My newly adjusted weight goal is 170 lbs. That’s 144.4 lbs of Lean Body Mass and 15% body fat. That’s in the middle of the athlete range of body fat and on the low end for an older man like myself.

[Later – Updated goal to 20.9% based on Ideal Body Fat percentage]

Modified Protein Sparing Modified Fast (PSMF)

I am calling what I am doing a Modified Protein Sparing Modified fast (PSMF) since the classical PSMF does not factor in fat oxidation rates.

I think it’s useful to factor in fat oxidation rates since that’s the maximum amount of fat a person can pull from their body per day. See my post, “Hypophagia – How much fat can I lose in a day?” for details.

Lyle McDonald’s Rapid Fat Loss Book

Lyle McDonald’s book “Rapid Fat Loss” (RFL) simply puts people on a particular amount of protein depending upon what stage of the diet a person is on. As the diet goes on and a person loses body fat their protein amount increases on Lyle’s method. So basically, his method is Very Low Carbs (except certain unlimited green veggies).

I think the fault in Lyle’s method isn’t so much that it leads to excessive protein consumption. Some would say that there’s no such thing as too much protein and within limits they could be right.

I think the fault in Lyle’s method is not factoring in the limits of hypophagia. Drop your calorie intake too low (below what the body can provide) and something has to give. If you can’t lose more than a particular amount of fat per day then why would you eat at a lower calorie amount than that?

 

PSMF – A Day’s Food/Supplements/Exercise/Biometrics

I’ve completed a day of logging everything with CRON-o-meter. Here’s the data entry part:

Bio-metrics were Weight, Body Fat percentage (from the scale), Body Temperature (used to determine if metabolism has dropped) and Blood Glucose.

Exercise was logged (CrossFit with warm-up and the resistance training portions).

Finally, the food I ate was carefully and completely logged. So how did I do compared to my goals? For overall calories I overshot by 2%. That’s great since I should never go under with PSMF.

The overall breakdown was also pretty good. I went under on my fat and over on my protein which balanced each other out. I did not exceed the carbohydrate number (net grams less than 20). That put me at a net deficit of 1131 calories. That would be about 2 lbs per week of loss.

 

Intermittent Fasting and Insulin Resistance

Long-time readers of this BLOG may remember that the initial seed of a thought here was to reduce Insulin Resistance. To that end, I found Dr Fung videos and decided to start Intermittent Fasting (IF). Here’s a study which returns back to that theme (Effect of intermittent fasting and refeeding on insulin action in healthy men; Nils Halberg, Morten Henriksen, Nathalie Söderhamn, Bente Stallknecht, Thorkil Ploug, Peter Schjerling, Flemming Dela; ).