I suffered from similar metabolic conditions that many people have today. I ate a regular “Standard American Diet” and I exercised regularly. I struggled to keep my weight down. My weight went up and down over the years. It was extremely frustrating. I even developed bilateral plantar fasciitis, a painful foot condition due to repetitive injury from running to “burn” off the excess calorie. I needed foot surgery in 2014 after failing stretching exercise, better shoes, and repeated steroid injections. Despite my best effort, I was diagnosed with pre-diabetes around January 2016. At that time, I weighed in at 172.6 lb (78.45 kg), and body mass index (BMI) at 27 - classified as overweight.
Due to chronic foot pain, increasing running on pavement to lose excess weight was out of the question. I cut back on the amount of food that I eat in effort to reduce calories, and I started a nightly routine of using the elliptical machine after work to minimize the impact on my poor feet. I used it to exercise one hour every night, 5 times per week and resting on weekends. I dedicated myself to the calorie hypothesis of weight control by adopting “EAT LESS MOVE MORE” for the next 12 months.
One year later, I had managed to lower my A1C from 5.8 to 5.6. My weight loss was zero lb with all the huffing and puffing on the elliptical machine and cutting back on the amount of food. I was resigned to the faith of development of adult onset diabetes mellitus type II, just like my paternal grandmother did and her daughter, my aunt. I have been dealt the “bad” gene, given a “bad deck of cards” by mother nature, so I just need to “suck” it up and start taking metformin for diabetes mellitus type II. At that time, I have been in medicine for 14 years starting with medical school (4 years), family medicine residency (3 years), and actively practicing medicine from 2010. With all my medical education and knowledge, the outlook was bleak for me.
One evening, I was coming home from work. I have been working as a family doctor by helping patients manage their diabetes and other metabolic diseases, patients just like me with pre-diabetic or diabetic already. My sister “dentist, more specifically prosthodontist” who is currently with the rank of Major in US Air Force forwarded me a youtube clip https://youtu.be/tIuj-oMN-Fk about Dr. Jason Fung talking about reversing diabetes mellitus 2 with therapeutic fasting. As an actively practicing physician, who is supposed to have latest information, board certified, all credentials up to date. I have never heard of reversing diabetes because I have been taught that diabetes is a progressive disease, which can only be managed by low-fat, wholegrain, fresh fruits, vegetable, exercise and diabetic medicines. Naturally I was SUPER skeptical.
I was taught that when someone develops diabetes mellitus type II. It is usually the result of obesity because the patient’s own pancreas cannot produce enough insulin to control the blood sugar due to insulin insufficiency, insulin resistance, or both. In traditional medical treatment of diabetes mellitus type II, if or when the body is not producing enough insulin to keep blood glucose under control. Oral medication(s) will be added to stimulate the pancreas to produce more insulin, and “extra” insulin will help to keep the blood glucose under control for an extended period of time.
Eventually, even the “extra” insulin from the pancreas will no longer control the blood glucose. Then, injectable insulin regimen is added to help control the blood glucose. Generally speaking, night-time or long acting insulin is added to manage the blood glucose. Ultimately, patients will be taking more and more diabetic medicines to control the blood glucose until patients died from diabetic complications such as heart disease, strokes, limb amputation or end-stage renal failure needed routine dialysis just to be alive.
After I came home, I started reading and doing more research on Dr. Jason Fung’s work on controlling insulin hormone by dietary changes through Low-Carb therapy and intermittent fasting strategies to treat the root causes of the diabetes mellitus type II, which is insulin resistance vs just symptomatically treating the high blood glucose with diabetic medications. Normally, the body makes very little amount of insulin hormone during fasting period. Then, there is a spike/surge immediately after meal to allow the body to store the “extra” food as glycogen and storage fat for later use.
Of the three macronutrients of carbohydrate, protein, and dietary fat. Carbohydrate ingestion leads to the highest insulin spike relative to protein/fat ingestion. Since excessive insulin is the problem, limiting carbohydrates such as sugar sweetened beverages, rice, bread, pasta, potatoes, and processed carbs such as cookies, chips, and ice cream are critical in reducing the degree of insulin resistance.
The idea is controlling insulin hormone by changing food selection (Low-Carb diet) and food timing (intermittent fasting). I told my wife that I want to change my eating habits to address the root causes of my pre-diabetes, central obesity, dyslipidemia, so meal-time will not be what it used to be.
In the back of my mind, if something bad happens to me in the quest to reverse my pre-diabetes. It is on me, I am an adult. I wouldn’t want to try this on my patients first. To my amazement, the pounds started shedding and new holes in my belts were needed. After about four weeks, I decided to ask my colleagues (also medical providers) about Low-Carb diet and intermittent fasting. Some heard of it and others have never heard of the concept. I was thinking to myself, “Andy, you are in the left field by yourself.”
After 3 months of learning, reading, and researching by putting the “thinking” cap on, I have come to the conclusion that the “traditional approach - aka old school” in dealing with weight problems, obesity, diabetes, and their treatments were just symptomatic management. They got the symptoms mixed up with the disease. The disease of diabetes mellitus type II is carbohydrate intolerance, leading to elevated blood glucose. We should treat excessive carbohydrate consumption (root cause), rather than piling on more diabetic medications to control the blood glucose.
The treatment for weight problem, pre-diabetes or diabetes is very simple, cutting out sugar, grain, starchy carbohydrates in the diet. The weight will shed and diabetes mellitus type II goes into remission. But, why so many patients who started Low-Carb diet failed in the long run? Because they don’t know why or how dietary changes affect their physiology and metabolism. How dietary changes affect the various hormones such as leptin, ghrelin, peptide yy, cholecystokinin, insulin, and more, and why mastering control of insulin hormone “master hormone” is key is to long term weight loss, better healthy, and avoiding the dreadful effects of the metabolic diseases.
My journey back to metabolic health started in earnest on February 14, 2017. I weighed 172.6 lb, triglyceride 335, HDL 47, ALT 69, and Hb-A1C 5.6. I started incorporating a Low-Carb diet along intermittent fasting as part of a new regimen to reduce my insulin resistance. By April 2017 “three months later”, I weighed 155.6 lb (lost 17 lb) and triglyceride 68, HDL 62, and Hb-A1C 5.6. By October 2017 “eight months later”, I weighed 150 lb (lost 22.6 lb) with triglyceride 85, HDL 60, and Hb-A1C at 5.5.
Fast forword 2.5 year “August 2019”, I have continued to weigh 150 lb, triglyceride 66, HDL at 53, Hb-A1C 5.2, ALT 22, fasting glucose 101 and insulin level at 9.8 “HOMAR-IR = 2.44”. I have lost weight, normalized my cholesterol dysfunction, very close to reverse my fatty liver (ALT < 20), but insulin resistance continues “Ideal HOMAR-IR < 1”. I have enjoyed much healthier metabolic health with Low-Carb and intermittent fasting lifestyle. Carbohydrate restriction, intermittent fasting, exercise, sleep, and sunlight have greatly improved my metabolic health - and continuing their applications are critical to prevent the metabolic diseases from coming back. This is my health journey, a new way of life, and not a “DIET”. Because when people start a diet, it is to “Die on a T”.