Extended Fasting

Not sure if I posted this or not but I am on an extended fast. I started this nine days ago and the only thing I have had since then is coffee (2-3 thermos’ a day) with a small amount of coconut oil in the coffee. I have added salt to my coffee on occasion as well. Tomorrow is Thanksgiving so I am ending the fast to eat with my kids. That will be a ten day fast.

This was a breeze. I feel like I have a bunch of energy. I even cleaned the house which is really strange for me.

Blood sugar numbers have been spectacular. Here’s the past two weeks.

two-weeks-ending-2016-11-22

I started the Extended Fast on Mon Nov 14. As you can see my blood sugar numbers are very good.

I stopped taking my Metformin a few days in because my blood sugar numbers have been really good without it. About a week later the numbers are still great. In fact, with lows in the mid 70’s I would not want the numbers much lower. I am still seeing a Dawn Syndrome effect but the number is still pretty low. Here’s my hourly modal numbers over the same period. You can see the effect of the Dawn Syndrome although it is difficult to tease out the fasted and non-fasted numbers since the period covered is two weeks.

two-weeks-ending-modals-2016-11-22

I have had no negative effects from the fast. Whenever I feel a leg cramp coming on I add salt. Whenever I feel lightheaded, I also add some salt.

I have been taking a multivitamin and my daily vitamin D every day. I am also taking a Calcium Citrate a day.

My weight is down about 15 lbs but I expect to regain about half of that.

Three Months – No Insulin

I’ve got a reason to celebrate today. Three months – no Insulin. So obviously I am not dead but what happened with my daily blood sugar numbers? My meter only goes to one month on the average but I downloaded the data and here’s what it looks like (averaged over three months):

abg-3months-2016-11-12

All of the daily averages are in the 80-120 range. My overall average is 101.5. That works out to a HbA1C value around 5.2. I haven’t had it tested yet but would expect my value to be somewhere around that number. That is pretty great.

I also went below the 50 lb scale drop on the work scale this past week so the weight loss is going really well also.

Clothes don’t fit all that well anymore though. I need a better belt and some new pants. I’ve been wearing XL tee shirts this past week too.

 

 

Four Day Fast

I did a four day fast from Monday evening through Friday evening this week. Easy breezy. Really easy. Felt strong and like I could have gone on for several more days easily. Think I might try a 7 day fast next.

What happens to me during a four day fast?

My Blood Sugar drops. My afternoon lows on the fourth day were 77. For several readings in the afternoon.  Here is my average of the four days of the fast.

abg-5dayfasting-2016-11-11

My weight drops. Around a pound a day maybe more although by calories count it has to be less than a pound a day. That’s because my expenditure is around 2500 calories a day and a pound is 3500 calories a day. That works out to less than a calorie a day.

I experienced no appreciable hunger and the bit that I did have was transient. Even the box of fresh donuts in the kitchen had no real appeal to me.

Mood was fairly flat which can be a bummer but it’s good to not be fed for flattening out ones mood.

Ordered Dr Jason Fung’s book on Fasting.

My third three day fast

Did my third three day fast this past week. I find I can do them easily starting Monday after dinner and resume eating on Thursday. I lose around four lbs on the fast but a lb or two returned after the fast. Net seems to be a couple of lbs which is better than they would be if I had not fasted.

One of the better benefits is the dip in Blood Sugar during the fast. By the third day my numbers go from the low 80’s to upper 90’s. Meter shows my averages as 101-103 for the 7 day, 14 day and 30 day. That should be an HbA1C of around the mid 5’s. Still seeing a Dawn Effect every day and a drop by dinner time.

Still doing Intermittent Fasting and LCHF. I eat on a 20 hour fast four hour eating schedule.

My work scale shows I have lost around 46 lbs so my guess is that I am down about 50 lbs in three months.

 

Ketosis Data

From (Ketone body metabolism and cardiovascular disease):

Ketone body oxidation becomes a significant contributor to overall energy metabolism within extrahepatic tissues in numerous physiological states, including the neonatal period, starvation, postexercise, and adherence to low-carbohydrate diets, when circulating ketone body concentrations increase from ∼50 μM in the normal fed state to up to 7 mM. Circulating ketone body concentrations rise to ∼1 mM after 16–20 h of fasting in healthy adult humans but can accumulate to as high as 20 mM in pathological states like diabetic ketoacidosis

Therefore, the metabolism of ketone bodies may influence numerous human disease states relevant to cardiovascular disease, including obesity, diabetes, atherosclerosis, and heart failure.

 

Mexican Food

Had Mexican food last night. Did well. Here’s how I did it.

  1. No chips/salsa.
  2. Ordered fajitas. Forget the name of it (Vallerta Fajitas maybe?). Had chicken, beef, chorizo and shrimp. Very oily/greasy. Included onions, green peppers, cauliflower, broccoli. Tasted good. No chips/salsa.
  3. No rice.
  4. No beans.
  5. No tortillas.

Blood sugar 2 hours later was 95 (pretty much normal for me).

Low Carb and the “Authorities”

From the American Diabetics Association 2008 (Nutrition Recommendations and Interventions for Diabetes):

ENERGY BALANCE, OVERWEIGHT, AND OBESITY

Recommendations

  • In overweight and obese insulin-resistant individuals, modest weight loss has been shown to improve insulin resistance. Thus, weight loss is recommended for all such individuals who have or are at risk for diabetes. (A)

  • For weight loss, either low-carbohydrate or low-fat calorie-restricted diets may be effective in the short term (up to 1 year). (A)

  • For patients on low-carbohydrate diets, monitor lipid profiles, renal function, and protein intake (in those with nephropathy), and adjust hypoglycemic therapy as needed. (E)

Wow. Back when I was a newly diagnosed T2D (in 2003) they were saying LC is bad. Now it is one of the recommended diets for Diabetics. Reading on…

The optimal macronutrient distribution of weight loss diets has not been established. Although low-fat diets have traditionally been promoted for weight loss, two randomized controlled trials found that subjects on low-carbohydrate diets lost more weight at 6 months than subjects on low-fat diets (19,20). Another study of overweight women randomized to one of four diets showed significantly more weight loss at 12 months with the Atkins low-carbohydrate diet than with higher-carbohydrate diets (20a). However, at 1 year, the difference in weight loss between the low-carbohydrate and low-fat diets was not significant and weight loss was modest with both diets. Changes in serum triglyceride and HDL cholesterol were more favorable with the low-carbohydrate diets. In one study, those subjects with type 2 diabetes demonstrated a greater decrease in A1C with a low-carbohydrate diet than with a low-fat diet (20). A recent meta-analysis showed that at 6 months, low-carbohydrate diets were associated with greater improvements in triglyceride and HDL cholesterol concentrations than low-fat diets; however, LDL cholesterol was significantly higher on the low-carbohydrate diets (21).

So everything (except LDL) was better with LC. And they did not differentiate between the various LDL (small particle size vs large).

 

Coffee and Insulin Resistance

Wasn’t too sure about what the title of this article should be. I was tempted to make it Coffee and Blood Sugar but I really need to adjust my thinking since Blood Sugar isn’t the problem, but insulin levels are.

The general concept that lowering Insulin levels also lowers Insulin resistance in the cells makes good sense. The problem is that there’s no available instrument I can use to determine Insulin levels. The only measurement I can do easily is blood sugar levels. Insulin kicks in when blood sugar levels rise. Carbs cause blood sugar to rise and Insulin to kick in. That’s the advantage a Low Carb diet brings to Insulin Resistance.

So why coffee? I have not been a fan of coffee. My preferred drink of choice is Diet Mountain Dew. Lots of caffeine and a taste that I used to like. It now tastes too sweet to me since I have gone LCHF. To replace the caffeine I have taken to drinking coffee. It started innocently enough. Drank some of the horrible coffee at work. Spotted a jar of instant coffee at Trader Joe’s and it was better than the stuff at work. Researched through a friend at work K-cup machine and actually purchased a Bella Single Cup brewstation.

Took this to the next level and actually started adding Ghee to coffee. Not too much, maybe a half teaspoon. I drink 2 mugs (12 oz each) of coffee a day. I’m adding maybe 50 calories to my day during what was previously a fast time. But since those calories are fat rather than carbs it’s not affecting my ketosis.

But all of this begs the question. Have I done myself a favor by trading something I like for something I am just beginning to learn to tolerate? Certainly it’s a more grown up thing to drink coffee but is it a more healthy choice?

By my own testing with my blood sugar meter Diet Mountain Dew really didn’t drive my blood sugar one way or the other. But there’s the question of what it was doing to my Insulin levels.

But, what does coffee do to blood sugar and Insulin? I see a small rise in my blood sugar when I drink my black coffee. And that’s what the literature says happens (Associations between the intake of caffeinated and decaffeinated coffee and measures of insulin sensitivity and beta cell function).

There is some evidence as well that the effect on Insulin Sensitivity is a temporary effect and that the longer term effect of coffee on Insulin Sensitivity is in fact a good effect (Caffeinated Coffee, Decaffeinated Coffee, and Caffeine in Relation to Plasma C-Peptide Levels, a Marker of Insulin Secretion, in U.S. Women):

Intakes of caffeinated and decaffeinated coffee and caffeine in 1990 were each inversely associated with C-peptide concentration in age-adjusted, BMI-adjusted, and multivariable-adjusted analyses. In multivariable analysis, concentrations of C-peptide were 16% less in women who drank >4 cups/day of caffeinated or decaffeinated coffee compared with nondrinkers (P < 0.005 for each). Women in the highest quintile compared with the lowest quintile of caffeine intake had 10% lower C-peptide levels (P = 0.02). We did not find any association between tea and C-peptide. The inverse association between caffeinated coffee and C-peptide was considerably stronger in obese (27% reduction) and overweight women (20% reduction) than in normal weight women (11% reduction) (P = 0.005).

C-peptide is proportional to Insulin although it has a longer half life. It looks as if this may be part of the reason that coffee is a good choice for diabetics. It may raise blood sugar in the short term but lower insulin resistance in the longer term.