Two Years of Eating WOEfully

Charting Steps to Avert Type II Diabetes

The acronym WOE in the title stands for Way of Eating, the de facto motto of a Facebook group called Reversing Diabetes.  The members of Reversing Diabetes are set on reversing or avoiding diabetes using diet, either alone or with conventional medicine.  Very early in 2014 I took a random blood glucose reading and was alarmed to learn I was on the road to Type 2 diabetes myself.  Here chronicled are my blood glucose readings as a function of personal experiments in what and how often I ate, the aim being to climb back down from the brink of diabetes.  None of this is a proper experiment -- for one thing its sole subject, me, is completely biased to a particular outcome, as is the researcher, also me.  The goal is to keep blood sugar and insulin low, thereby protecting eyesight, hands and feet, kidneys and who knows what else as long as can be.

My two weapons in this battle have been to fast periodically and to shun carbohydrates (examples: sugar, starch, flour, potatoes, rice, bread, and pasta).  It is working.  Remember though, that while fasting may be a useful course in combating Type II diabetes, it is likely harmful, maybe lethal, in the case of Type I Diabetes.  Please be sure of your condition if you attempt any personal experiments of your own.

After nearly two years at this, I'm convinced that what is eaten and how often one eats can keep Type II diabetes in check without drugs. Maybe this Way of Eating can work for you if your own blood sugar readings are similar to the ones I saw at the beginning of 2014.

If you have just learned that you are headed towards Type II Diabetes yourself, you likely have the same questions I did two and a half years ago.  Can I turn this around?  What do I have to do?  Will it work?  Will it hurt?  How long will it take?  How long will it last?  Maybe the notes and data below will be useful to you.  Scroll down two years back, headed by the 2014 graph and the title Year 2014 in Review.

A plot of my fasting blood sugar readings by date.  The bar on the abscissa during the second half of February marks a Caribbean cruise during which I suspended intermittent fasting but tried to maintain LCHFMP.  It's early in the year so there's not much to see here.  Scroll down to my 2015 data if you want to see how things have been over the longer term.  If you're just starting out with LCHF or fasting, you'll want to see my 2014 data and read my notes.  Scroll down, all the way down, to the 2014 chart.

Today

Tuesday, May 24, 2016

This morning's fasting blood glucose was 5.1 mmol/L, or 92 mg/dL according to my slide rule.  Since my run of 5.5-and-under ended Saturday after five months of great fasting bloods, I took that day off and ate whatever.  You don't want to know.  Today's 5.1 represents me back on track with LCHF and IF.  (Why am I using a slide rule when I have a laptop and Google's search-field arithmetic right at my fingertips?  Analog numbers so much warmer than the digital ones, don't you find?)

This Month

For about a month now, whenever it's possible to do so, I have been tracking macros.  Carbs averaged 35 g, protein 77 g, and fat 120 g.  In terms of percent calories, that's 9, 20, and 71. Watching and weighing seems to have brought my fasting bloods down a small step.  What's different?  The carb calculators taught me how carb rich some vegetables were, specifically Brussel sprouts and nuts.  Whereas I thought I was doing a great job, just OK is more accurate.  So loading my plate with Brussel sprouts a few days back beside a couple of slivers of beef is backwards!  I thought too my almond butter was a life saver.  Well, if it is a life saver, then so too is peanut butter.  All to say, I have not been as strict as I thought I was.  It's time to pay attention to even more numbers.  (Which for some of us is fun.)

March's average was 4.6.  April closed at 4.6, and May's is sitting at 4.7.

This Year

Yesterday began a new streak of 5.5 and under readings, two days in a row.  So we've got 143/145 good days this year, 99% in 2016.  By this time last year I had overshot 5.5 five times.  Progress?  I'll take it.  It's early in the year so these comments spill back into 2015.  Since November 2014, so for a year and a half now, I fast on Wednesdays, eat LCHF the other days of the week.  Since August 2015 I also keep a 6-hour feeding window, so the Wednesday fasts, when they do take place, are 42-hour fasts.  This regimen is working well in maintaining health.  My weight is stable, registering a normal BMI.  The Wedesday fasts are conditional to having a fasting blood sugar reading of at least 4.5; anything lower than that reverts the day to the regular 18-hr fast:6-hr feed.  I went on a cruise vacation from the 14th to the 26th of February, during which I suspended intermittent fasting and my conditional Wednesday fasts, but continued to keep carbs at bay.  I'm back to my feeding regimen beginning with the 27th of February.

For 100 days from mid April to July, 2015, I fasted intermittently 16:8 but found no difference in fasting blood sugars to 100 days before (back to early January, 0.1 mmol/L or 2 mg/dL lower, ns).  Perhaps the 16:8 regimen is more effective in individuals with higher fasting blood glucose readings than mine.  Another possible explanation is that my once per week 36-hr fasts (actually 40-hr) are already doing all the maintenance that's needed, that there's nothing more to be gained by adding intermittent fasting to the game.  My current experiment, started 23-July, is to use 18:6 as the fast:feed hours.  By September 2nd, 42 days in, the difference was robust: random numbers would match or better this result only once in ten thousand trials.  It's a difference of only 0.36 mmol/L (6 or 7 mg/dL).  In standard deviation units the effect size is 0.66, a medium effect using Cohen's labels.  Intermittent fasting was also suspended on September 2nd 2015 because of a vacation, but resumed in October.

Current Maintenance Regimen

Early in 2014 I was fasting M-W-F and had dropped carbs.  I gradually realized the importance of increasing fats so I rampped fats up too, but the HF part of LCHF trailed the LC maybe by -- let's call it a month.  Seeing the immediate effect on blood sugar and the dropping weight (losing fat), I shifted to M-Th fasting in May.  There was a telling break from fasting in October 2014 during a European vacation that saw fasting blood sugar creep.  In November 2014 I resumed fasting but only one fast per week, on Wednesdays.  I added a conditional rule that the Wednesday fast would be cancelled if I woke to anything under 4.0, and later adjusted that to under 4.5.  From April to July 2015 I added intermittent fasting at 16:8, took a break from fasting but kept LCHF in October 2015 (as much as possible during a vacation) and resumed intermittent fasting at 18:6 in November.  With all that charting behind me I think I've settled on a maintenance regimen of:
  1. low carbohydrate, high fat, up to medium protein food choices,
  2. eating during a 6-hr window each day, leaving 18 uninterruped hours with no meal and no snack,
  3. full fasts on Wednesdays -- in the context of intermittent fasting 18:6 it becomes a 42-hr fast -- as long as my fasting blood sugar is 4.5 mmol/L (81 mg/dL) or greater.  If under, Wednesday reverts to 18:6.
If you think eating like this and fasting border insanity, then you won't believe the next bit. You might as well leave this page now. But I'll say it anyway: You don't get hungry if you eat like this.  Well, OK, you do, but it is nothing anywhere near what you imagine it to be if you have not tried it.  The biggest surprise folks have when they try fasting, after they've had a few weeks of eating low carb, moderate protein, and high fat, is how they can go without eating and *not* feel hungry.  Still don't believe it?  Try it.

Now Watching

In a crude way I'm keeping track of alcohol and fruit.  Crude, because I'm just noting whether I have a drink or a fruit and note the next day's fasting blood sugar.  With enough observations, their impact will poke through.  In the case of beer and wine, I drink socially, maybe twice to four times per week, and modally it would be one drink -- a beer, a glass of wine -- per occasion.  I don't drink anything harder, just haven't acquired a taste for it.  I think I've noticed fasting bloods being a little higher after drinks.  It's just an impression at this point so I've decided to go after it formally. Beginning 09-Apr-16, I'm logging drinks.  Here are the running averages: no drink, n = 26, 4.6; drink, n=15, 4.8.  It's way too early to say anything about drinking.  Let's wait until June before interpreting this.  As to fruit, I will often have one during the day, and it usually takes care on its own of filling my carb limit.  Based on 14 fruit days the average is 4.9 whereas the 19 no-fruit days register 4.7.  Again, too early to invest confidence in an interpretation, but the difference skirted statistical significance few days back but it is now not even close (p = .12 today (as long as you neglect the fact that the stats are performed daily). In other words, random numbers would achieve differences as great as this on one trial out of every 4 or 5 trials with this number of draws.

Silly Numeric Accomplishments (that help keep me in line)

Runs At or Below 5.5 (99) Blood Sugar

1st: 08-Dec-15 20-May-16, 165 days  terminated by a 5.6 on the 21st.
2nd: 21-Sep to 15-Nov-15, 56 days  done in by 5.6 on the 16th.
3rd: 02-Aug to 19-Sep-15, 49 days  ended by a 5.8 on the 20th.

Current Run: Today's 5.1 marks Day 2 of a run of 5.5 mmol/L and under.  Saturday's big number closed my longest run to date, not only a new first place, but a run three times longer than second and third places.  It's too long to aim for another first place run, but if I eat properly, maybe I can replace 3rd place in a couple of months.

The current first place run survived a Caribbean cruise and the end of year holidays too!  I started keeping track of healthy runs a little over a year ago when I made it through the feed fest we call Christmas and New Year's without breaching 5.5.  The present streak also made it through the holidays -- of 2015 -- and it bumped the prior year's holiday run of 36 days off the podium.  The run is still going, having moved into second place not quite two months ago and is now sitting securely in first.  My determination to eat properly is helped by paying attention to silly numeric accomplishments like this. It really does keep me in line. I am just too aware of potentially breaking a great run with each temptation.

The Year 2015 in Review

In 2015 I fasted on Wednesdays (water and morning coffee only, from Tuesday after supper through to breakfast on Thursday) and ate low-carbohydrate high-fat on the other days.  Lapses?  Sure, but occasional, truly occasional.

What was that low point in February?  Two-point-eight mmol/L or 50 mg/dL.  Oh, you mean: What caused it?  During a Wednesday 36hr fast we had a snowfall that I cleared.  The low point was the next day's fasting blood glucose reading.  For the record I felt fine.

The Year 2014 in Review

2014 Chart

It has been two years now, started with a random blood glucose reading taken on January 1st, 2014, about an hour after breakfast.  I forget the value, but my brother told me it was too high, that I needed to see my doctor.  Within a few days I obtained a meter of my own -- they're free in Canada -- and began monitoring my fasting blood sugar, where "fasting" in this context means first thing in the morning, after not eating overnight.  The chart is a plot of fasting blood glucose readings.  The green band represents healthy levels.  Below 4 mmol/L, readings are considered hypoglycaemic, too low in other words.  A level above 7 is a symptom of diabetes.  Between 5.5 and 7, one is said to be "pre-diabetic", with a fair chance of developing diabetes within a decade.  Additional comments about the various phases labeled on the chart (BC, 1FpW, etc.) follow below.

Abbreviations

BC: Better Choices (of food).  FpW: Fasts per Week.
Hey, Prediabetes...Read this!

Get mad?  Whatever.  Get a meter?  Yes!

2014: BC (Better Choices)

From the 11th through to the 25th of January, 2014, I made so called better food choices (BC on the chart), based largely on a few minutes' internet research, having read that sweet potatoes were better than ordinary potatoes and brown rice was better than white.  Despite the substitutions, my blood sugar remained at 7 mmol/L.  In this scale of measurement, 7 is the boundary between prediabetes and proper diabetes.  That diabetes can insidiously blind you and lead to the amputation of feet and hands terrified me. Various sources on the internet said this level was reversible by changes in lifestyle.  Lifestyle 180° became the plan.

So I ate foods said to be better on the basis of qualitative statements like "this food is better than that one for diabetics."  I also learned about the Glycemic Index where foods are quantified according to how similar they are to sugar in increasing blood glucose.  (I'll be using blood sugar and blood glucose interchangeably.)  I learned too about Glycemic Load.  Load is a Glycemic Index adjusted for the amount that would typically be eaten.  So something like chocolate sprinkles would score high on index but lower on load as they're not typically eaten by the spoonful.  It was disappointing to read how little the better choices were better than the poor ones.  To hear that sweet potatoes should be substituted for white potatoes is to think they're only 5% bad.  But they're not.  Foods described as better choices are only marginally better.  They're typically better by only 5 or 10%, a difference that's readily washed out by an extra fork full of the better stuff.  I decided by the last week in January to drop the better choices altogether.

2014: 3 Fasts per Week

Beginning on the last week in January I got tough with my bloods.  I remembered a little about energy storage and use from lectures on metabolism that I attended in the late seventies.  I read a few articles on the internet, notably one by Shurie on how well intermittent fasting worked for him.  I read about the Glascow study, and stumbled on to a paper recounting how starvation was used routinely in Boston to manage diabetes before insulin injections became popular.  Starvation was used before the distinction between Type I and Type II Diabetes was understood.  (The original notes show that starvation worked really well for some patients, generally the older ones, but not at all for others, generally children who were described as too far gone.  My hunch is that Type II vs. Type I, respectively, was the critical distinction.)  I decided to try periodic fasting myself.

I started with three fasts per week, on Mondays, Wednesdays, and Fridays.  I thought of them as 24-hour fasts but 36-hours is more accurate.  For Monday's fast, for example, I would stop eating on Sunday night after supper and resume with breakfast on Tuesday.  On days between fasts I ate whatever I wanted to eat.  The amount eaten evidently did not make up for the fasts judging by the weight lost over the months, about 30 lbs, starting with an overweight BMI to one that was squarely normal. 

Generally speaking, complete fasts were easier for me than fasts restricted to a set number of calories.  It was just easier not to eat anything than it was to plan meals, and measure calories, cook and clean up...for what?  Six hundred measly calories?  They just weren't worth the fuss and bother.  Besides, if I were to eat a 600 calorie meal on fast days, I would get ravenous for one on subsequent fast days.  Hunger can be trained to give up once it learns it's not going to get its way.

The results were immediate and spectacular.  The fasting blood sugar reading on Monday the 27th, that is, just before the first fast, was 7.0 mmol/L.  Had my doctor obtained readings of 7 or higher on two visits I would have been diagnosed with proper diabetes, likely Type II because of my age.  On Saturday morning, after that very first week of Monday-Wednesday-Friday fasting, the blood sugar concentration had dropped to 4.9 mmol/L.  Wow!  That one week of three, all-day fasts brought my bloods from the very top of the pre-diabetic range down to normal right away.  You can see the dramatic drop for yourself at the left edge of the graph where there are four points around 7 taken on three successive Saturdays and the following Monday, during which I made "better" food choices, followed by a plunge to 4.9 on the Saturday following the first week of 3 fasts.  I continued with three fasts per week through to the beginning of May.  Through this period I generally took readings on days I expected to be highest and lowest.  They were all fasting blood readings, meaning always before eating anything (or nothing) in the morning.  The expected highests were on Mondays after two eating days, Saturday and Sunday, in a row.  The expected lowests were on Saturdays as these followed the third, 36-hour fast that week.  The jagged appearance of the data is thus no accident as the readings were taken twice weekly; on Monday mornings, generally peaks, and Saturday mornings, generally troughs.

During my first few weeks of making better choices and for some time after, I kept running into articles about low-carbohydrate-high-fat (LCHF) diets.  Really?  Could the enemy of the past five diet decades now be an ally?  Was fat actually good for you?  And had the former friend in bread and pasta betrayed us? I thought that happened only in war.  So, pretty well co-incident with 3 fasts per week I began avoiding carbs.  Later, as more and more articles explained how wrong we had been about fats, I started increasing my consumption of fats.  Went from 0% yogurt to 2%.  Brought bacon back.  And, yes, if someone made Greek yogurt at 10% MF, I'd be buying that, as long as there were no sugar in it.  (Note added the next day: After just having written about seeking 10% MF yogurt, I actually found some. Yum.)


New 32" 516s.  By early May my 34" jeans could be pulled off without undoing them.  Preventing diabetes had been my only concern.  The weight loss, from an overweight category BMI to a normal one, was a side effect.  Not bad for a side effect, eh?  (Note: May 2015: It's a year later and the weight is still off...Jan '16: ditto.)

So, whereas the graph emphasizes the fasting, it is important to remember there are several possible causes to the drop in blood sugar readings.  The salient factor is the fasting.  I say salient partly because fasting is drama compared to a diet change and partly because I began fasting before learning about LCHF.  Along with the fasting I consumed fewer carbs.  Along with the lower consumption of carbs was a greater intake of fats.  And along came a consequent loss in weight.  I can say with some assurance that if you eat like this, your blood sugar will drop.  But, is it due to the fasting, the fewer carbs, the increased fat intake, or the weight loss?  It would be up to carefully controlled research to dissect the contributions of these potential independent or intervening variables.

2014: 2 Fasts per Week

From Monday, May 5, through to Thursday, October 2, I fasted twice per week, on Mondays and Thursdays.  Like the others they were nominally 36-hour fasts.  A fast on Thursday, for example, meant finishing eating on Wednesday evening and resuming on Friday morning.  Measures were taken more frequently, on the morning of a fast day, that is, after 2 or 3 days of eating in a row, and on the mornings after fasts.  Again, this accounts for the sawtooth shape of the data, low points being morning measures after fasts and high points being morning measures after 2- or 3-day runs of eating.

The first thing I experienced was great relief at how easy it was to fast on two days instead of three.  Although I had dropped only one fasting day, it felt like I had gained two eating days.  Math defying, isn't it?  During the three fast-days period I looked forward to one eating day on Tuesday, another on Thursday, and two more on the weekend.  But having switched to fasting on Mondays and Thursdays, I now looked forward to two eating days in a row on Tuesday and Wednesday, and three in a row now that weekend eating began on Friday.  So the arithmetic properly counts five eating days versus four.  But the psychological impact was some exponential function of the actual number of eating days.

The trend established during three fasts per week continued into the two fasts per week.  Overall there was a downward trend, and quite regularly in the second half of the two-fasts period I dipped into hypoglycaemic territory.  As soon as I started getting blood glucose readings under 4.0, I added a conditional rule: Fasting would be cancelled on a Monday or Thursday if the reading was under 4.0 mmol/L.  Now over this course I also got better at shunning carbs and favouring fats, so one cannot be certain of what caused what.  I was ready to shift to only one fast day per week when a European Vacation insinuated itself into my plans.

2014: None, European Vacation

On September 30, a Tuesday, we flew to Istanbul on a European vacation with October 22 as the return date.  I left determined to keep measuring and fasting.  It's not easy to keep to routine when travelling, especially if forced to be eating out most of the time.  I did fast on schedule on the first Thursday -- I had been fasting on Mondays and Thursdays as long as I scored 4.0 mmol/L or higher on mornings of planned fasts.  On Saturday we boarded the Ryndam for a one-week cruise of Agean ports of call, some in Turkey, some in Greece.  On Monday the 6th I blew a 3.9.  I couldn't believe my luck.  Here I was on a cruise with all kinds of food available practically at all times of day in virtually any quantity, and my first fast of the cruise was cancelled!  Woohoo!  Experiencing my own reaction of relief -- no, elation -- to the cancellation, I changed my mind about fasting during the vacation.  Instead I would eat every day, and maybe be a little careful to avoid carbs.  I'd continue to read my bloods.  Born of convenience or gluttony, the rationale soon evolved to one of scientific curiousity.  Maybe I had cured myself; maybe a month off from fasting would reveal how well my system was responding to food.  Yeah, that's it.  Let's try eating every day for the rest of the month and call it an experiment.

As you can see from the period labelled None, corresponding roughly to the month of October, morning blood sugar readings rose steadily through the month.  Some of it was due to the reintroduction of servings of fruit beginning back in August some time and some to the difficulty in finding foods that were completely carb free.  Moussaka, for example, is often made with a layer of potato.  Whereas the filling of spanakopita -- spinach and feta -- is particularly good for diabetics, the filo, composed of flour, is not.  So in October I ate every day (except on Oct 2) but made the best choices available to avoid carbs.  By the end of the month I was registering low fives, and so decided to resume fasting on the first Monday in November.

2014: 1 FpW (One Fast per Week)

Looking back it's clear that with two fasts per week my morning bloods showed a downward trend, such that by the Autumn I regularly registered in hypoglycaemic territory.  So, beginning with the first Monday in November, I decided to try just one fast per week.  At this writing, which is on the 12th of November, 2015, after two Monday-only fasts, I'm encouraged to think this is the right approach.  Maybe it will be the way to maintain bloods at the right level over the long term, maybe not.  But for sure it is the right thing to try for now.  During this phase I will be taking measures roughly every day.

30 December 2014.  Too early for a year-end review?  Maybe.  But with only one day to go in the year, it's safe to say that one fast per week is doing its job of maintaining things on an even keel.  I have not re-introduced carbs, but do take in small quantities, often in the form of fruit and sometimes as gastronomic trimmings, like the filo pastry on my wife's Beef Wellington.  The plan for 2015?  Well, I will start the year with one fast per week and continue to shun carbs, completely in the case of processed food, and partially when it comes in natural packages like apples.  So, I'm eager to start a new chart.

Bottom Line: Am I Cured?

After a couple of years at this I know how to keep my blood sugar at a healthy level.  It's not hard, it doesn't feel like work at all.  Giving up high carb foods is easy because there are are so many high-fat, delicious foods to eat.  Eating fat keeps you from getting hungry.  As a side bonus, this WOE results in weight loss.  I dropped about 30 lbs in the first few months. I'm still at the low weight more than a year and half later, still registering a normal BMI.

I don't think I can go back to eating all the high carb foods I used to eat, not routinely and not in great amounts.  But then I don't want to either, this not being a conscious decision of discipline, but rather an absent compulsion to do so.  Carbs are not forbidden altogether, but will be consumed in moderation.  A few weeks ago, for example, I had a smoked meat sandwich with its two slices of bread.  Through the holidays (Christmas 2014) I had the odd piece of chocolate, sugary mint, or a cookie.  Occasionally with meals I downed the odd small potato, carrot, and filo too.  So carbs have not been banished from my life, but are now rare treats.  I might even try a full desert one of these days, although I don't see why; I don't miss them.

The short answer is yes, I am cured, and the full cure was complete about five or six months into the regimen.  Why I say so will be explained on a separate page, under development.  This is a qualified "cured" as I know better than to think I can consume desserts and soft drinks every day.  It's clear that I will remain susceptible to insulin resistance brought on over the long term by eating grains, root vegetables, and sugars both natural and artificial.  But do I worry about diabetes complications?  Not any longer, and in that sense, I am cured.

Bottom Line, latest version: May, 2015.