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12 comments:
Might I be diabetic or prediabetic?
Here's my story: I'm trying to lose 20 lbs. I'm male, 5'8" 184 lbs.
For over 9 months now I’ve been eating strictly paleo (no grains, minimal veggies, lots of meat, fish, eggs). No gluten (which makes a huge difference in my mood). Generally <50g carbs/day.
I rock climb almost every day, religiously.
In spite of the diet and exercise, I just can’t seem to lose any weight. So I started reading about it, which led me to Gary Taubes' books. Began to suspect I had high fasting insulin and/or Type II.
I check to be sure I’m in ketosis every time I pee, and I usually am. Thyroid seems to be ok. (I tried thyroid meds, and they seem to do little, if anything.) I took several hundred BS readings and kept track of them in a spreadsheet. Most days BS tends to be a around 105 to 110 fasting in the morning.
I noticed a cyclical pattern: for a few weeks, it tends to be around 85 or so, then jumps up over 100 for a few weeks. An hour after a meal, BS tends to be about 115 to 120. A1c has ranged from 5.1% to 5.4% over the last 9 months.
Shouldn't my fasting BS consistently be in the low 80s? I talked this over with my doc, and we agreed I'd try metformin, 750mg, 2x/day. Found that it makes me nauseous (it's a great way to diet: makes you lose all interest in food). Oh, and my fasting insulin dropped from 4 to 2 after going paleo.
Any advice?
Do I have diabetes?
Am I prediabetic?
Why can't I lose weight?
Thanks.
You have normal blood sugars (with a high normal fasting sugar).
There are people--a small number, but they exist--who see higher numbers when they eat a very low carb/high fat diet.
And also, after a prolonged stint of low carbing, some of us do see our fasting sugars rise. One thing that happens is a subtle change in Thyroid hormone (Euthyroid syndrome) involving T3. That will stop weight loss cold--and stalled weight loss is much more common than getting to goal on very low carb diets (as you can see on any of the diet support groups). After a while people often feel exhausted, too.
That's why I don't recommend long term ketogenic dieting, but suggest stabilizing at a carb level slightly over the ketogenic boundary and watching calories very carefully after a year of VLCD.
If you do carb-up, do it very slowly, adding 5 grams a week until you get over the ketogenic limit (at which point you suddenly regain the glycogen-associated water weight you lost the first week.) Go up another 10 grams or so and then stay there for a while to let your body think it isn't starving (which is what ketosis tells it long term.)
The people who sell these faddish very low carb diets never discuss this issue, but it is well known and a real problem for a lot of us.
Thank you very much for the suggestions, Jenny. A few things I forgot to mention: I am 47 years old, and also I had radiation to the thyroid about 20 years ago. So I always suspect thyroid problems.
I will try your suggestions, but first I'm going to try a thyroid med (Naturethroid, which has T3) once again. It's worth a try.
Thanks again.
I found this in the FDA Prescribing Information for Nature Thyroid:
"In case of concomitant diabetes mellitus, the daily dosage of antidiabetic medication may need
readjustment as thyroid hormone replacement is achieved. If thyroid medication is stopped, a downward readjustment of the dosage of insulin or oral hypoglycemic agent may be necessary to avoid hypoglycemia.
At all times, close monitoring of urinary glucose levels is mandatory in such patients."
This suggests that the thyroid medication with both hormones in it can raise blood sugars.
Supplementing his patients with T3 alone was what was originally recommended by Dr. Eades on his web site back in the 1990s, but he removed the page and now says he never recommended it.
Hmmm...that's interesting, because when I was taking naturethroid, my BS readings tended to run high, so I stopped it, and they dropped about 15 to 20 points. Then they rose again, about 2 weeks later.
I did not know about the Dr. Eads controversy. So T3 only will not raise blood sugar?
JM,
I dont' know. I just know that prolonged low carb dieting can lower available T3.
I just heard from someone else with the same issue this past week.
JM,
I am having exactly the same problem with you. I was diagonosed with T2 last Sept, then very low carb, and my fasting sugar was dropped below 90 for half a year, then jumped to soemwhere between 90 and 100 now. A1C was dropping though, from 8.6% to 5.6%，5.4%， 5.3%.
Let me know the results with your T3 experiment. My TSH was high (4.7) 9 years ago, then dropped to 1.8 somehow without any treatment.
I am thinking of testing it again very soon.
otter
Otterotter,
Have you eliminated all gluten from your diet? If you had high TSH (and, presumably, low T4) along with symptoms of diabetes, it's very likely that you have an autoimmune reaction attacking both your pancreas and your thyroid.
Have you been tested for Hashimoto's disease (thyroid antibodies)? If these levels are even slightly elevated, then get rid of all wheat, barley, etc. and follow a very strict gluten-free diet. You probably already did that when you changed your diet, but even a little occasional gluten can mess you up.
The normal progression is 1) thyroid antibodies 2) pancreas antibodies 3) cerebellum antibodies (causes loss of coordination).
So you may, in fact, have the early stages of Type I diabetes.
Just a hunch...this information is what got me started thinking about all this.
Gluten intolerance is the latest fad explanation for all mortal ills. There are people who have this problem, but there are plenty of other reasons people develop autoimmune conditions.
There's nothing wrong with eliminating gluten for a while to see what happens, but I know too many people who have done that without seeing any improvement in their health conditions to believe it is the panacea that enthusiasts claim it to be.
Mostly, it seems to be getting a lot of promotion of late because there are a ton of very expensive new high-carb foods that are gluten free filling upscale grocery stores.
Soy is just as likely to cause problems as gluten, so can other bean proteins. Milk proteins cause problems for some. Each of us is different and despite people's desire to cure everything with a solution that can be expressed in one sentence, it takes a lot of experimentation and work to find what will work for each of us.
I completely agree with Jenny regarding gluten. It could easily be soy, milk, or something else. Whatever it is, though, it's very likely causing an autoimmune reaction. When you have thyroid and pancreas symptoms simultaneously, that's a very strong clue.
(In my case, I also had mysteriously elevated liver enzymes, for many years. Went away when I got rid of gluten.)
There are in fact some rather good AI programs for diagnosing medical problems. Those which focus of a specific problem area are generally speaking nearly as good as the expert consultants whose responses they try to model, and a lot better than the average medic. The more general "what have I got?" ones tend to be better than the average doc, and especially good at pointing out the possibilities of more rarely diagnosed disorders.
But they're not used, not because of any defects in their performance, but for legal reasons. If an AI program gives a wrong diagnosis or advice who is to blame? More specifically, who can be taken to court and sued for malpractice if the ostensible "culprit" is an AI program?
It is fear of expensive and professionally damaging answers to such questions which has forestalled the development and use of what in other areas of similar expertise (such as exploring for oil) has proved to be a useful and profitable use of AI's so called "expert systems".
Chris Malcolm
retired UK AI lecturer (US prof) and T2 diabetic, A1C 5.5%, no meds, low pp spike diet.
Chris,
That is a very good point, and one worth considering.
But given how flawed most doctors' advice is on so many conditions and how well-protected they are from malpractice suits, there must be some clever legal way to get around this problem.
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