Interesting Dr follow up with LCHF friendly doc for T2
cstehansen
Posts: 1,984 Member
After more than a year of frustration trying to get my BG into normal range, I found a doctor on Jimmy Moore's site that is in my area (http://lowcarbdoctors.blogspot.com/). Everything I have tried has had limited and only short term success. A1c peaked at 6.6, but I have since been in a range of 5.9 to 6.3. GP and Endo were both pretty useless with the "just take a pill" attitude and "this is progressive, so the best you can hope for is to just decline slower" mentality that is prevalent in the diabetes medical community.
Below is a lot of detail. I wanted to post this just because I thought there may be some out there who could benefit from this. Surely, I am not the only one who doesn't fit the stereotypical mold.
Nothing about my BG made sense to me. I was athletic at 6'1" and 195 lbs and bf around 20% which is not too bad for a desk jockey in his mid 40's. I have never been significantly overweight and only have one uncle with diabetes (who happens to be a couch potato with a horrible diet and 100+ lbs overweight).
My new doctor, Luan Pho, spent an hour talking with me on my first appointment and took about 40 gallons of blood for various tests - ok, I may be exaggerating a bit on how much blood he took, but it was a lot.
I had read how, although the vast majority of people with T2D are insulin resistant, that there can be other causes including other hormone issues, beta cell dysfunction causing low insulin production, sleep issues/stress. Both of my previous doctors refused to acknowledge any possibility that I was not IR and therefore would not test.
Yesterday, I had my follow up with Dr Pho where I found out I am NOT IR. My fasting insulin was 3 which is a bit below normal. There were actually 2 other tests, one which had a calculated IR rating which was also in the "optimal" category. The other was one which took some of my white blood cells and grew them and then did testing on them which showed I they had no IR. I also had no issues with processing fructose. Clearly, IR is NOT my issue.
There were 2 things Dr Pho pointed out that likely were my issue. The first, and in his opinion the most impactful, was stress. Basically, he says it appears the stress (cortisol release) is causing excessive glucagon release for the "fight or flight" response enough to make my BG high, but not high enough to elicit a significant insulin response to bring it down. This makes it likely, if I don't get stress under control, to stay in the pre-diabetic range indefinitely without progressing to full T2D. This makes sense given my personality is similar to my dad's who has had an A1c in the 5.6-5.9 range since 1993 without ever going higher or lower than that range.
I won't bore anyone with the details, but the softball sized hail that destroyed my house (roughly $80k worth of damage) and forced my family to live 2 towns away in an apartment for 4 months was just one of several things this year which made 2016 a year will not be sad to see go. I will advise if you find yourself in a situation like this, don't do as I did and act as your own general contractor to allow for extra money to do some upgrades. The stress and time associated with that probably were not worth it.
The other issue was some micronutrient deficiencies. One I found interesting was iodine. My TSH was good, but my T4 was borderline and my T3 was low. Apparently, the iodine deficiency was related to this. My B vitamins were all either borderline or low as well. Manganese and magnesium were also borderline as well as one other thing I can't remember. Lastly, my Omega 3/Omega 6 ratio was off.
The good news is my immune system was way above average and my inflammation tests all came back very positive.
I have about 8-10 pages of lab results. He went over much of it, but I have also Googled some of the items to get more information.
As part of my action plan, I am going to stop BG testing 8-10 times a day, stop obsessively tracking every bit of food and water I take in and stop squeezing in research with every spare minute I can find as I think these behaviors have likely only added stress to my life. Instead, I will only track FBG in the morning and when I eat something unusual and maybe just a random PP reading here and there to make sure I am not getting really high readings. I do have other stress control plans, but those are a bit more personal.
I am also toning down my workouts since I may be overdoing it to the point of causing cortisol spikes which lead to excessive glucagon release just like stress does.
I am also making some changes in my diet as well as taking some supplements to address the deficiencies.
As an additional note, one of the tests showed that genetically, I would not absorb statins properly even if I was taking them and would be likely to suffer muscle pains/cramping if I did take them. I thought it was interesting there was a genetic marker they could use to see this.
Below is a lot of detail. I wanted to post this just because I thought there may be some out there who could benefit from this. Surely, I am not the only one who doesn't fit the stereotypical mold.
Nothing about my BG made sense to me. I was athletic at 6'1" and 195 lbs and bf around 20% which is not too bad for a desk jockey in his mid 40's. I have never been significantly overweight and only have one uncle with diabetes (who happens to be a couch potato with a horrible diet and 100+ lbs overweight).
My new doctor, Luan Pho, spent an hour talking with me on my first appointment and took about 40 gallons of blood for various tests - ok, I may be exaggerating a bit on how much blood he took, but it was a lot.
I had read how, although the vast majority of people with T2D are insulin resistant, that there can be other causes including other hormone issues, beta cell dysfunction causing low insulin production, sleep issues/stress. Both of my previous doctors refused to acknowledge any possibility that I was not IR and therefore would not test.
Yesterday, I had my follow up with Dr Pho where I found out I am NOT IR. My fasting insulin was 3 which is a bit below normal. There were actually 2 other tests, one which had a calculated IR rating which was also in the "optimal" category. The other was one which took some of my white blood cells and grew them and then did testing on them which showed I they had no IR. I also had no issues with processing fructose. Clearly, IR is NOT my issue.
There were 2 things Dr Pho pointed out that likely were my issue. The first, and in his opinion the most impactful, was stress. Basically, he says it appears the stress (cortisol release) is causing excessive glucagon release for the "fight or flight" response enough to make my BG high, but not high enough to elicit a significant insulin response to bring it down. This makes it likely, if I don't get stress under control, to stay in the pre-diabetic range indefinitely without progressing to full T2D. This makes sense given my personality is similar to my dad's who has had an A1c in the 5.6-5.9 range since 1993 without ever going higher or lower than that range.
I won't bore anyone with the details, but the softball sized hail that destroyed my house (roughly $80k worth of damage) and forced my family to live 2 towns away in an apartment for 4 months was just one of several things this year which made 2016 a year will not be sad to see go. I will advise if you find yourself in a situation like this, don't do as I did and act as your own general contractor to allow for extra money to do some upgrades. The stress and time associated with that probably were not worth it.
The other issue was some micronutrient deficiencies. One I found interesting was iodine. My TSH was good, but my T4 was borderline and my T3 was low. Apparently, the iodine deficiency was related to this. My B vitamins were all either borderline or low as well. Manganese and magnesium were also borderline as well as one other thing I can't remember. Lastly, my Omega 3/Omega 6 ratio was off.
The good news is my immune system was way above average and my inflammation tests all came back very positive.
I have about 8-10 pages of lab results. He went over much of it, but I have also Googled some of the items to get more information.
As part of my action plan, I am going to stop BG testing 8-10 times a day, stop obsessively tracking every bit of food and water I take in and stop squeezing in research with every spare minute I can find as I think these behaviors have likely only added stress to my life. Instead, I will only track FBG in the morning and when I eat something unusual and maybe just a random PP reading here and there to make sure I am not getting really high readings. I do have other stress control plans, but those are a bit more personal.
I am also toning down my workouts since I may be overdoing it to the point of causing cortisol spikes which lead to excessive glucagon release just like stress does.
I am also making some changes in my diet as well as taking some supplements to address the deficiencies.
As an additional note, one of the tests showed that genetically, I would not absorb statins properly even if I was taking them and would be likely to suffer muscle pains/cramping if I did take them. I thought it was interesting there was a genetic marker they could use to see this.
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Replies
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My only advice after reading this is that you have an historical marker made for the entrance to your doctor's premises. "On this site resides a qualified medical professional who actually understands my lifestyle and invested the time and effort to show me how to improve it."
Of course, you run the risk of never again being able to get another appointment with this doctor after word gets out and patients are lined up around the block. Or he loses his license to practice medicine when the AMA finds out he advised neither another prescription nor some high priced procedure.16 -
A piece of unsolicited advice- hope you don't mind. I would shoot for 8 hours of sleep every night.3
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A piece of unsolicited advice- hope you don't mind. I would shoot for 8 hours of sleep every night.
I have been gradually increasing my sleep. When this started, I was averaging just a few minutes over 5 hours per my fitbit. I am up to over 6 1/2. Chris Kresser had an interesting interview with a sleep expert which made some clarifications on the recommendation for 8 hours while discussing a recent study. The actual amount of sleep (i.e. what Fitbit tracks after subtracting any restless time) doesn't need to be 8 hours. It is the total restful time (time going to bed with lights out until rising) that they recommend be 8 hours. And that 8 hours is based on how much the average person gets of restful sleep during that 8 hours (what my Fitbit is tracking). That amount is actually less than 7 hours typically.
That said, I probably need to get a little more sleep, but may not be as far away as I originally thought. I do agree, in our society, sleep is not given the attention it should, and functioning on less sleep is often viewed as a badge of honor in many circles.3 -
@cstehansen - Was your Omega 3/6 ratio off in your diet or in lab results?1
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This was really interesting to read - thanks for sharing! And congrats on finding such a fantastic doc - I've briefly looked at that website, but there aren't any LC friendly docs in my area.0
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Thanks for sharing. My a1c was 5.7 in October and I suspect part of it is due to stress (tantruming child almost daily, anxiety about driving). Not to mention stress triggers hunger for me. I think low-carb is helping me with stress.3
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@cstehansen - Was your Omega 3/6 ratio off in your diet or in lab results?
I don't have the results with me and there were so many numbers on there that it would be impossible for a mere mortal such as me to remember them all. I will look that up and reply later.1 -
cstehansen wrote: »After more than a year of frustration trying to get my BG into normal range, I found a doctor on Jimmy Moore's site that is in my area (http://lowcarbdoctors.blogspot.com/). Everything I have tried has had limited and only short term success. A1c peaked at 6.6, but I have since been in a range of 5.9 to 6.3. GP and Endo were both pretty useless with the "just take a pill" attitude and "this is progressive, so the best you can hope for is to just decline slower" mentality that is prevalent in the diabetes medical community.
Below is a lot of detail. I wanted to post this just because I thought there may be some out there who could benefit from this. Surely, I am not the only one who doesn't fit the stereotypical mold.
Nothing about my BG made sense to me. I was athletic at 6'1" and 195 lbs and bf around 20% which is not too bad for a desk jockey in his mid 40's. I have never been significantly overweight and only have one uncle with diabetes (who happens to be a couch potato with a horrible diet and 100+ lbs overweight).
My new doctor, Luan Pho, spent an hour talking with me on my first appointment and took about 40 gallons of blood for various tests - ok, I may be exaggerating a bit on how much blood he took, but it was a lot.
I had read how, although the vast majority of people with T2D are insulin resistant, that there can be other causes including other hormone issues, beta cell dysfunction causing low insulin production, sleep issues/stress. Both of my previous doctors refused to acknowledge any possibility that I was not IR and therefore would not test.
Yesterday, I had my follow up with Dr Pho where I found out I am NOT IR. My fasting insulin was 3 which is a bit below normal. There were actually 2 other tests, one which had a calculated IR rating which was also in the "optimal" category. The other was one which took some of my white blood cells and grew them and then did testing on them which showed I they had no IR. I also had no issues with processing fructose. Clearly, IR is NOT my issue.
There were 2 things Dr Pho pointed out that likely were my issue. The first, and in his opinion the most impactful, was stress. Basically, he says it appears the stress (cortisol release) is causing excessive glucagon release for the "fight or flight" response enough to make my BG high, but not high enough to elicit a significant insulin response to bring it down. This makes it likely, if I don't get stress under control, to stay in the pre-diabetic range indefinitely without progressing to full T2D. This makes sense given my personality is similar to my dad's who has had an A1c in the 5.6-5.9 range since 1993 without ever going higher or lower than that range.
I won't bore anyone with the details, but the softball sized hail that destroyed my house (roughly $80k worth of damage) and forced my family to live 2 towns away in an apartment for 4 months was just one of several things this year which made 2016 a year will not be sad to see go. I will advise if you find yourself in a situation like this, don't do as I did and act as your own general contractor to allow for extra money to do some upgrades. The stress and time associated with that probably were not worth it.
The other issue was some micronutrient deficiencies. One I found interesting was iodine. My TSH was good, but my T4 was borderline and my T3 was low. Apparently, the iodine deficiency was related to this. My B vitamins were all either borderline or low as well. Manganese and magnesium were also borderline as well as one other thing I can't remember. Lastly, my Omega 3/Omega 6 ratio was off.
The good news is my immune system was way above average and my inflammation tests all came back very positive.
I have about 8-10 pages of lab results. He went over much of it, but I have also Googled some of the items to get more information.
As part of my action plan, I am going to stop BG testing 8-10 times a day, stop obsessively tracking every bit of food and water I take in and stop squeezing in research with every spare minute I can find as I think these behaviors have likely only added stress to my life. Instead, I will only track FBG in the morning and when I eat something unusual and maybe just a random PP reading here and there to make sure I am not getting really high readings. I do have other stress control plans, but those are a bit more personal.
I am also toning down my workouts since I may be overdoing it to the point of causing cortisol spikes which lead to excessive glucagon release just like stress does.
I am also making some changes in my diet as well as taking some supplements to address the deficiencies.
As an additional note, one of the tests showed that genetically, I would not absorb statins properly even if I was taking them and would be likely to suffer muscle pains/cramping if I did take them. I thought it was interesting there was a genetic marker they could use to see this.
What an awesome doc you found, good for you, sounds like a keeper for sure!
I'm a T2 diabetic, off meds now for the most part thanks to my very low carb diet. Exercise is an important part of the equation too. The #1 thing that drives up my BG now is most definitely stress, to the point where I've needed to use insulin again periodically when it's become too bad, and that's during periods when my diet and exercise have remained consistent, making the stress factor the big red flag. I wish I could learn to let life's chaos just bounce off me, but it's easier said than done... that'll be the life challenge I'll be working on until the day it finally kills me.
3 -
It's not a long-term fix, but Dr. Bernstein discovered through personal experience that Inderal (propanalol) can be an effective brake on BG spikes in times of short-term, situational stress.
http://community.myfitnesspal.com/en/discussion/10439244/t2ds-anxiety-high-bg-and-a-simple-fix3 -
It's not a long-term fix, but Dr. Bernstein discovered through personal experience that Inderal (propanalol) can be an effective brake on BG spikes in times of short-term, situational stress.
http://community.myfitnesspal.com/en/discussion/10439244/t2ds-anxiety-high-bg-and-a-simple-fix
This is interesting. I am the odd one, though - which is normal for me. I don't have issues like stage fright or anything like that. What seems to be my issue is more of a constant state of high stress just to the level of keeping a higher than ideal bg level all the time. The only spikes I have had - by that I mean over 120 - have been after working out, which has gotten it up as high as 150. This is why I am looking at how I can adjust my workout to be more appropriate for a guy my age and stop trying to keep up with those in the gym who are young enough to be my kids. It is fun to beat a guy half my age in a pull up or push up contest when he thinks he's in pretty good shape. However, the strain I am putting on myself is probably not worth it. I had one of the test results (again too many to remember them all) had a reading the doc thought was too high even though it fell into the lab's "normal" range. When I looked up what could cause it to be elevated, one of the first things listed was overly strenuous exercise causing muscle damage.
At the same time, I am wondering if some of the beta blockers you can get over the counter could be useful in those rare occasions when I do have those symptoms he discussed that feel like low BG, but when I test end up being a bit high - i.e. 115-120. That happens occasionally, but pretty randomly.1 -
cstehansen wrote: »After more than a year of frustration trying to get my BG into normal range, I found a doctor on Jimmy Moore's site that is in my area (http://lowcarbdoctors.blogspot.com/). Everything I have tried has had limited and only short term success. A1c peaked at 6.6, but I have since been in a range of 5.9 to 6.3. GP and Endo were both pretty useless with the "just take a pill" attitude and "this is progressive, so the best you can hope for is to just decline slower" mentality that is prevalent in the diabetes medical community.
Below is a lot of detail. I wanted to post this just because I thought there may be some out there who could benefit from this. Surely, I am not the only one who doesn't fit the stereotypical mold.
Nothing about my BG made sense to me. I was athletic at 6'1" and 195 lbs and bf around 20% which is not too bad for a desk jockey in his mid 40's. I have never been significantly overweight and only have one uncle with diabetes (who happens to be a couch potato with a horrible diet and 100+ lbs overweight).
My new doctor, Luan Pho, spent an hour talking with me on my first appointment and took about 40 gallons of blood for various tests - ok, I may be exaggerating a bit on how much blood he took, but it was a lot.
I had read how, although the vast majority of people with T2D are insulin resistant, that there can be other causes including other hormone issues, beta cell dysfunction causing low insulin production, sleep issues/stress. Both of my previous doctors refused to acknowledge any possibility that I was not IR and therefore would not test.
Yesterday, I had my follow up with Dr Pho where I found out I am NOT IR. My fasting insulin was 3 which is a bit below normal. There were actually 2 other tests, one which had a calculated IR rating which was also in the "optimal" category. The other was one which took some of my white blood cells and grew them and then did testing on them which showed I they had no IR. I also had no issues with processing fructose. Clearly, IR is NOT my issue.
There were 2 things Dr Pho pointed out that likely were my issue. The first, and in his opinion the most impactful, was stress. Basically, he says it appears the stress (cortisol release) is causing excessive glucagon release for the "fight or flight" response enough to make my BG high, but not high enough to elicit a significant insulin response to bring it down. This makes it likely, if I don't get stress under control, to stay in the pre-diabetic range indefinitely without progressing to full T2D. This makes sense given my personality is similar to my dad's who has had an A1c in the 5.6-5.9 range since 1993 without ever going higher or lower than that range.
I won't bore anyone with the details, but the softball sized hail that destroyed my house (roughly $80k worth of damage) and forced my family to live 2 towns away in an apartment for 4 months was just one of several things this year which made 2016 a year will not be sad to see go. I will advise if you find yourself in a situation like this, don't do as I did and act as your own general contractor to allow for extra money to do some upgrades. The stress and time associated with that probably were not worth it.
The other issue was some micronutrient deficiencies. One I found interesting was iodine. My TSH was good, but my T4 was borderline and my T3 was low. Apparently, the iodine deficiency was related to this. My B vitamins were all either borderline or low as well. Manganese and magnesium were also borderline as well as one other thing I can't remember. Lastly, my Omega 3/Omega 6 ratio was off.
The good news is my immune system was way above average and my inflammation tests all came back very positive.
I have about 8-10 pages of lab results. He went over much of it, but I have also Googled some of the items to get more information.
As part of my action plan, I am going to stop BG testing 8-10 times a day, stop obsessively tracking every bit of food and water I take in and stop squeezing in research with every spare minute I can find as I think these behaviors have likely only added stress to my life. Instead, I will only track FBG in the morning and when I eat something unusual and maybe just a random PP reading here and there to make sure I am not getting really high readings. I do have other stress control plans, but those are a bit more personal.
I am also toning down my workouts since I may be overdoing it to the point of causing cortisol spikes which lead to excessive glucagon release just like stress does.
I am also making some changes in my diet as well as taking some supplements to address the deficiencies.
As an additional note, one of the tests showed that genetically, I would not absorb statins properly even if I was taking them and would be likely to suffer muscle pains/cramping if I did take them. I thought it was interesting there was a genetic marker they could use to see this.
When you have some time would you mind posting in here the names of the tests that you took? My husband was recently labeled T2D, he is also thin and tall and always has been except for overeating while we lived in Sydney, he lost that weight and has not put any of it back on, he stays around 170 lbs. without trying and is 6'tall. I would love to know what tests to get his dr. to administer because he was on statens for a while, but ended up unable to walk they effected him so adversely.0 -
cstehansen wrote: »It's not a long-term fix, but Dr. Bernstein discovered through personal experience that Inderal (propanalol) can be an effective brake on BG spikes in times of short-term, situational stress.
http://community.myfitnesspal.com/en/discussion/10439244/t2ds-anxiety-high-bg-and-a-simple-fix
This is interesting. I am the odd one, though - which is normal for me. I don't have issues like stage fright or anything like that. What seems to be my issue is more of a constant state of high stress just to the level of keeping a higher than ideal bg level all the time. The only spikes I have had - by that I mean over 120 - have been after working out, which has gotten it up as high as 150. This is why I am looking at how I can adjust my workout to be more appropriate for a guy my age and stop trying to keep up with those in the gym who are young enough to be my kids. It is fun to beat a guy half my age in a pull up or push up contest when he thinks he's in pretty good shape. However, the strain I am putting on myself is probably not worth it. I had one of the test results (again too many to remember them all) had a reading the doc thought was too high even though it fell into the lab's "normal" range. When I looked up what could cause it to be elevated, one of the first things listed was overly strenuous exercise causing muscle damage.
At the same time, I am wondering if some of the beta blockers you can get over the counter could be useful in those rare occasions when I do have those symptoms he discussed that feel like low BG, but when I test end up being a bit high - i.e. 115-120. That happens occasionally, but pretty randomly.
That's a good question! Since I take the XR version of Glucophage, I've been wondering what my options are for something that's a little quicker-acting.....
Your BG sounds well under control - have you gone through the possible scenarios for your A1c being falsely elevated?0 -
Thanks for posting this in detail and glad you found a Dr who is willing to work with you---my yearly check up is today and I'll be better prepared as a result of your great share.
Good Luck in reducing stress & sleeping more.1 -
cstehansen wrote: »It's not a long-term fix, but Dr. Bernstein discovered through personal experience that Inderal (propanalol) can be an effective brake on BG spikes in times of short-term, situational stress.
http://community.myfitnesspal.com/en/discussion/10439244/t2ds-anxiety-high-bg-and-a-simple-fix
This is interesting. I am the odd one, though - which is normal for me. I don't have issues like stage fright or anything like that. What seems to be my issue is more of a constant state of high stress just to the level of keeping a higher than ideal bg level all the time. The only spikes I have had - by that I mean over 120 - have been after working out, which has gotten it up as high as 150. This is why I am looking at how I can adjust my workout to be more appropriate for a guy my age and stop trying to keep up with those in the gym who are young enough to be my kids. It is fun to beat a guy half my age in a pull up or push up contest when he thinks he's in pretty good shape. However, the strain I am putting on myself is probably not worth it. I had one of the test results (again too many to remember them all) had a reading the doc thought was too high even though it fell into the lab's "normal" range. When I looked up what could cause it to be elevated, one of the first things listed was overly strenuous exercise causing muscle damage.
At the same time, I am wondering if some of the beta blockers you can get over the counter could be useful in those rare occasions when I do have those symptoms he discussed that feel like low BG, but when I test end up being a bit high - i.e. 115-120. That happens occasionally, but pretty randomly.
That sounds pretty reasonable.
Attia has moved into longevity and reducing stress. Meditation was included in that. Have you looked into something like that? That could help some.
I believe he takes a low dose of metformin as a preventative measure too. Perhaps slowing down your gluconeogenesis might be a solution if reducing stress doesn't work.
Nice appointment. We need more docs like that out there.4 -
@cstehansen - Was your Omega 3/6 ratio off in your diet or in lab results?
I looked much more closely at this section last night. Basically, the way the report reads, the 6's are just classified as low, mid and high based on population norms and mine were in the high at 48.5% with over 46% being high. The 3's on the other hand are measured based on optimal, borderline and low and mine were in the borderline at 2.97% over 4.5 is optimal and under 2 is low. The ratio works out to 13.99 which is only measured as low in regard to the general population. However, as I think many in this group (being much better informed on health matters) know, the general population has a very poor ratio which leads to the inflammatory issues so prevalent in our society. The report has a note that says there are recommendations to have the ratio at 9.0. I have read in various places everything from 1.0 to 6.0 as being ideal.
The thing is that no one needs to work to get more Omega 6 in their diet. The key is getting enough Omega 3. We also have to be careful because many of the foods shown to be a "good source of Omega 3" have even higher levels of Omega 6. Walnuts for example have more than 4x more Omega 6 than Omega 3. That is something that will help with the ratio, but not nearly as much as salmon or sardines which have no Omega 6.
There is also a ratio between Arachidonic Acid (AA) which is an Omega 6 and EPA which is one of the Omega 3's. The ideal ratio here is said to be 5.0. Mine was 16.8. Again, my AA was just barely into the high category, but my EPA was in borderline (15.6-50 with higher being better) at 17.6, so the bigger issue was the EPA being too low.4 -
retirehappy wrote: »cstehansen wrote: »After more than a year of frustration trying to get my BG into normal range, I found a doctor on Jimmy Moore's site that is in my area (http://lowcarbdoctors.blogspot.com/). Everything I have tried has had limited and only short term success. A1c peaked at 6.6, but I have since been in a range of 5.9 to 6.3. GP and Endo were both pretty useless with the "just take a pill" attitude and "this is progressive, so the best you can hope for is to just decline slower" mentality that is prevalent in the diabetes medical community.
Below is a lot of detail. I wanted to post this just because I thought there may be some out there who could benefit from this. Surely, I am not the only one who doesn't fit the stereotypical mold.
Nothing about my BG made sense to me. I was athletic at 6'1" and 195 lbs and bf around 20% which is not too bad for a desk jockey in his mid 40's. I have never been significantly overweight and only have one uncle with diabetes (who happens to be a couch potato with a horrible diet and 100+ lbs overweight).
My new doctor, Luan Pho, spent an hour talking with me on my first appointment and took about 40 gallons of blood for various tests - ok, I may be exaggerating a bit on how much blood he took, but it was a lot.
I had read how, although the vast majority of people with T2D are insulin resistant, that there can be other causes including other hormone issues, beta cell dysfunction causing low insulin production, sleep issues/stress. Both of my previous doctors refused to acknowledge any possibility that I was not IR and therefore would not test.
Yesterday, I had my follow up with Dr Pho where I found out I am NOT IR. My fasting insulin was 3 which is a bit below normal. There were actually 2 other tests, one which had a calculated IR rating which was also in the "optimal" category. The other was one which took some of my white blood cells and grew them and then did testing on them which showed I they had no IR. I also had no issues with processing fructose. Clearly, IR is NOT my issue.
There were 2 things Dr Pho pointed out that likely were my issue. The first, and in his opinion the most impactful, was stress. Basically, he says it appears the stress (cortisol release) is causing excessive glucagon release for the "fight or flight" response enough to make my BG high, but not high enough to elicit a significant insulin response to bring it down. This makes it likely, if I don't get stress under control, to stay in the pre-diabetic range indefinitely without progressing to full T2D. This makes sense given my personality is similar to my dad's who has had an A1c in the 5.6-5.9 range since 1993 without ever going higher or lower than that range.
I won't bore anyone with the details, but the softball sized hail that destroyed my house (roughly $80k worth of damage) and forced my family to live 2 towns away in an apartment for 4 months was just one of several things this year which made 2016 a year will not be sad to see go. I will advise if you find yourself in a situation like this, don't do as I did and act as your own general contractor to allow for extra money to do some upgrades. The stress and time associated with that probably were not worth it.
The other issue was some micronutrient deficiencies. One I found interesting was iodine. My TSH was good, but my T4 was borderline and my T3 was low. Apparently, the iodine deficiency was related to this. My B vitamins were all either borderline or low as well. Manganese and magnesium were also borderline as well as one other thing I can't remember. Lastly, my Omega 3/Omega 6 ratio was off.
The good news is my immune system was way above average and my inflammation tests all came back very positive.
I have about 8-10 pages of lab results. He went over much of it, but I have also Googled some of the items to get more information.
As part of my action plan, I am going to stop BG testing 8-10 times a day, stop obsessively tracking every bit of food and water I take in and stop squeezing in research with every spare minute I can find as I think these behaviors have likely only added stress to my life. Instead, I will only track FBG in the morning and when I eat something unusual and maybe just a random PP reading here and there to make sure I am not getting really high readings. I do have other stress control plans, but those are a bit more personal.
I am also toning down my workouts since I may be overdoing it to the point of causing cortisol spikes which lead to excessive glucagon release just like stress does.
I am also making some changes in my diet as well as taking some supplements to address the deficiencies.
As an additional note, one of the tests showed that genetically, I would not absorb statins properly even if I was taking them and would be likely to suffer muscle pains/cramping if I did take them. I thought it was interesting there was a genetic marker they could use to see this.
When you have some time would you mind posting in here the names of the tests that you took? My husband was recently labeled T2D, he is also thin and tall and always has been except for overeating while we lived in Sydney, he lost that weight and has not put any of it back on, he stays around 170 lbs. without trying and is 6'tall. I would love to know what tests to get his dr. to administer because he was on statens for a while, but ended up unable to walk they effected him so adversely.
I am still going through this because it is a ton of information. I was thinking about trying to get a copy of all of it and adding it so you could see all the tests. Been a bit crazy lately, so not sure when I can do it. I will of course need to omit some personal info. No offense intended to anyone in this group, but I'm not a big fan of personal info on the internet. I am sure you can understand that. I also need to figure out the best way to do this also since it is several pages.2 -
cstehansen wrote: »It's not a long-term fix, but Dr. Bernstein discovered through personal experience that Inderal (propanalol) can be an effective brake on BG spikes in times of short-term, situational stress.
http://community.myfitnesspal.com/en/discussion/10439244/t2ds-anxiety-high-bg-and-a-simple-fix
This is interesting. I am the odd one, though - which is normal for me. I don't have issues like stage fright or anything like that. What seems to be my issue is more of a constant state of high stress just to the level of keeping a higher than ideal bg level all the time. The only spikes I have had - by that I mean over 120 - have been after working out, which has gotten it up as high as 150. This is why I am looking at how I can adjust my workout to be more appropriate for a guy my age and stop trying to keep up with those in the gym who are young enough to be my kids. It is fun to beat a guy half my age in a pull up or push up contest when he thinks he's in pretty good shape. However, the strain I am putting on myself is probably not worth it. I had one of the test results (again too many to remember them all) had a reading the doc thought was too high even though it fell into the lab's "normal" range. When I looked up what could cause it to be elevated, one of the first things listed was overly strenuous exercise causing muscle damage.
At the same time, I am wondering if some of the beta blockers you can get over the counter could be useful in those rare occasions when I do have those symptoms he discussed that feel like low BG, but when I test end up being a bit high - i.e. 115-120. That happens occasionally, but pretty randomly.
That sounds pretty reasonable.
Attia has moved into longevity and reducing stress. Meditation was included in that. Have you looked into something like that? That could help some.
I believe he takes a low dose of metformin as a preventative measure too. Perhaps slowing down your gluconeogenesis might be a solution if reducing stress doesn't work.
Nice appointment. We need more docs like that out there.
My personality type which is one of "I'm must fix it" is my primary obstacle. The good part of this is I am not one that will just take the pill(s) my doctor wanted to give me but rather am looking to actually resolve the underlying problem. The bad part is I can tend to get a bit obsessive.
I am not in a situation where I need/want to understand the entire report, but need to be careful about getting overly obsessed with all of it.
As for gluconeogenesis, that doesn't seem to be a problem. In fact, although my protein level was in the normal range, it was low enough that my doctor (who again is 100% on board with LCHF) said I may need to increase my protein intake a little bit. @RalfLott just posted something on a different thread about research that excessive glucagon may be the primary issue behind T2D. This is in line with what my doctor said was the issue with me. He said I seem to be producing this and releasing it into my blood stream at too high of a rate. The little bit of research I have seen on this seems to indicate this is mostly hereditary. That generally means it is hereditary or they don't have a clue and so they assume it is, IMO.0 -
@cstehansen - the one thing that stood out in that interpretation about the thyroid stuff is something that I've recently learned myself. Your insulin being so low (which we all know is just a snapshot, but low is still low, even if it is the lowest part of your range, etc.) could also have an affect on the thyroid function. Insulin actually sends signals to the thyroid to assist in setting metabolic function...it tells your metabolism how much to turn on the afterburners...so insulin being too low is actually a contributing factor there, too.
Iodine, B vitamins, D3, and other related thyroid support things have long been in my scope... I've been working on the Omega 3's, too... I haven't found a way to consume sardines that doesn't involve crackers or gluteny bread and such, so I might work on getting more salmon in... Do you know if canned is an acceptable choice here? I'm not the biggest fan of fresh salmon - and I also know that affording truly wild caught salmon isn't in my game plan at the moment. LOL
I'm excited for you to have all this information to experiment with...and such an insightful doctor who cares and is willing to dig deep. My doc has been talking for a few years about the genetic marker testing stuff, but they still don't have it in house yet. I'm excited to do it, so we can fine tune some treatment things, but I can't afford the full mess out of pocket.
Looking forward to the continuing adventures!1 -
KnitOrMiss wrote: »@cstehansen - the one thing that stood out in that interpretation about the thyroid stuff is something that I've recently learned myself. Your insulin being so low (which we all know is just a snapshot, but low is still low, even if it is the lowest part of your range, etc.) could also have an affect on the thyroid function. Insulin actually sends signals to the thyroid to assist in setting metabolic function...it tells your metabolism how much to turn on the afterburners...so insulin being too low is actually a contributing factor there, too.
Iodine, B vitamins, D3, and other related thyroid support things have long been in my scope... I've been working on the Omega 3's, too... I haven't found a way to consume sardines that doesn't involve crackers or gluteny bread and such, so I might work on getting more salmon in... Do you know if canned is an acceptable choice here? I'm not the biggest fan of fresh salmon - and I also know that affording truly wild caught salmon isn't in my game plan at the moment. LOL
I'm excited for you to have all this information to experiment with...and such an insightful doctor who cares and is willing to dig deep. My doc has been talking for a few years about the genetic marker testing stuff, but they still don't have it in house yet. I'm excited to do it, so we can fine tune some treatment things, but I can't afford the full mess out of pocket.
Looking forward to the continuing adventures!
The thyroid part seems to be circular, so if iodine helps the one side, it should help the other. It will take some time for me to really see. Fortunately my D3 was good. The doc said most people are deficient and nearly all diabetics are even if they spend all day in the sun because their bodies don't process it properly. I do spend 30-40 minutes a day at lunch out taking a walk and look for times to go outside except when it is cold, so I get plenty of sun exposure.
I know you mentioned not liking spicy food. Too bad because hot sauce and sardines...mmmmm.
As far as canned salmon, according to this link (http://nutritiondata.self.com/facts/finfish-and-shellfish-products/9242/2) is good for Omega 3's. Given sardines are one of the recommendations for Omega 3 and they are always canned, I can't see why canned salmon wouldn't be good.
As for wild caught salmon, living far from the Atlantic or Pacific here in Texas, it is rare to come by fresh without a premium price. However, I recently found it at Aldi's frozen for under $4 a lb. It is sold in 1 lb and 2 lb packs of 4 oz fillets. I was a bit skeptical at first, so I bought the smaller bag. It was good, so I went back and bought the bigger bag. I would assume frozen may be better than fresh for people here in the middle of the country much like frozen veggies are frequently better than "fresh" ones because they are frozen immediately whereas the "fresh" product spends 1-3 days in transport to get to the store. If I remember correctly you are in OK, so nowhere near the ocean as well.3 -
KnitOrMiss wrote: »@cstehansen - the one thing that stood out in that interpretation about the thyroid stuff is something that I've recently learned myself. Your insulin being so low (which we all know is just a snapshot, but low is still low, even if it is the lowest part of your range, etc.) could also have an affect on the thyroid function. Insulin actually sends signals to the thyroid to assist in setting metabolic function...it tells your metabolism how much to turn on the afterburners...so insulin being too low is actually a contributing factor there, too.
Iodine, B vitamins, D3, and other related thyroid support things have long been in my scope... I've been working on the Omega 3's, too... I haven't found a way to consume sardines that doesn't involve crackers or gluteny bread and such, so I might work on getting more salmon in... Do you know if canned is an acceptable choice here? I'm not the biggest fan of fresh salmon - and I also know that affording truly wild caught salmon isn't in my game plan at the moment. LOL
I'm excited for you to have all this information to experiment with...and such an insightful doctor who cares and is willing to dig deep. My doc has been talking for a few years about the genetic marker testing stuff, but they still don't have it in house yet. I'm excited to do it, so we can fine tune some treatment things, but I can't afford the full mess out of pocket.
Looking forward to the continuing adventures!
Just thought I'd mention how my daughter loves to eat salmon. I buy the single serve pouches and she spreads some cream cheese onto a low carb tortilla and then adds the salmon and rolls it up like sushi. She even cuts it and eats it like sushi. It tastes pretty good and I'm not a huge fan of salmon that isn't fresh and grilled. Sometimes she mixes it up with mayo and pickle relish like tuna and still eats it with the tortilla. That honestly just tastes like tuna to me. lol3 -
Sunny_Bunny_ wrote: »KnitOrMiss wrote: »@cstehansen - the one thing that stood out in that interpretation about the thyroid stuff is something that I've recently learned myself. Your insulin being so low (which we all know is just a snapshot, but low is still low, even if it is the lowest part of your range, etc.) could also have an affect on the thyroid function. Insulin actually sends signals to the thyroid to assist in setting metabolic function...it tells your metabolism how much to turn on the afterburners...so insulin being too low is actually a contributing factor there, too.
Iodine, B vitamins, D3, and other related thyroid support things have long been in my scope... I've been working on the Omega 3's, too... I haven't found a way to consume sardines that doesn't involve crackers or gluteny bread and such, so I might work on getting more salmon in... Do you know if canned is an acceptable choice here? I'm not the biggest fan of fresh salmon - and I also know that affording truly wild caught salmon isn't in my game plan at the moment. LOL
I'm excited for you to have all this information to experiment with...and such an insightful doctor who cares and is willing to dig deep. My doc has been talking for a few years about the genetic marker testing stuff, but they still don't have it in house yet. I'm excited to do it, so we can fine tune some treatment things, but I can't afford the full mess out of pocket.
Looking forward to the continuing adventures!
Just thought I'd mention how my daughter loves to eat salmon. I buy the single serve pouches and she spreads some cream cheese onto a low carb tortilla and then adds the salmon and rolls it up like sushi. She even cuts it and eats it like sushi. It tastes pretty good and I'm not a huge fan of salmon that isn't fresh and grilled. Sometimes she mixes it up with mayo and pickle relish like tuna and still eats it with the tortilla. That honestly just tastes like tuna to me. lol
@Sunny_Bunny_ One thing I know I don't like is smoked salmon! I tried making the cream cheese fat bombs with smoked salmon, and barely choked it down. I remember my mom making salmon patties (with crackers, eggs, and such), and I remember dipping them in ketchup. LOL So I know I can eat it sometimes... I love tuna with mayo and relish... And I like sushi with the spicy mayo (See, @cstehansen - I do like some spicy, I just like spicy with flavor, not spicy that burns my tastebuds to death!)...but I try to limit it, due to the rice...so I can see that I might do some kind of salmon, with sriracha mayo and cucumbers, carrots, and such... Maybe an inside out sushi roll type thing - like eggroll in a bowl, but cold? Hmm....food for thought. I wish i liked cream cheese more... But when SAD, I couldn't tolerate it, so I can only do it in blends now...
I've tried different fish oil supplements...but it's almost impossible to find a good one, and most of the summits we've listened to said a lot of them can actually create inflammation instead of help reduce it - though admittedly I didn't completely understand the mechanism...1 -
@kntOrMiss, I make sardine with some paleo mayo and pickles mashed up, then use lettuce leaves to roll that up and no crackers involved. If your lettuce leaves are smallish, double or triple layer them to get a size you can easily handle.
As long as the cans don't have BHA in them both canned sardines and salmon should be ok a couple of times a week. The only reason I don't eat more fish, I love it, is you do need to be careful of mercury in fish. Also if my husband tries to supplement with fish oil, he breaks out something horrible. But he can eat it when it is still in fish form.
I find Costco has Alaskan wild caught salmon at a good price, flash frozen so as good as fresh. I'm in Colorado and even Rainbow Trout are farm raised, no fresh ones unless you go fishing.
I admit that I splurge on fresh caught Copper River salmon when it is in season and being flown down to the states only iced down. It is very expensive but to me worth every penny. Going to Copper River area of Alaska in the season is on my bucket list 2 -
https://authoritynutrition.com/wild-vs-farmed-salmon/
Farmed salmon has a 3x higher ratio of Omega 6:Omega 3 than wild. Something to possibly consider.2 -
Hate to have to supplement fish with fish oil!0
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I am continuing to go through all the reports. This section shows some genetics testing that could be useful. The first one is the one which I found very interesting as it indicates my likelihood of having statin induced myopathy is 4.5 times higher than normal and my genotype means - "decreased statin metabolizer" - basically, if I took a statin, I would not get the full benefit (accepting for argument's sake that lower cholesterol is a benefit) and I am more susceptible to the negative side effects. Even with that, the producer of the report puts in the statement, "Moderate to low doses of water soluble statins.....if indicated, are recommended." This shows that the statin culture is so strong that even the labs can't seem to grasp the concept that they are not for everyone. My doctor made it very clear that with these results he would not prescribe a statin for me.
2 -
One other item I found interesting is the incongruity with my BG numbers. As the first pic shows, my glucose and fructose metabolism is good. The second shows my HOMA-IR (insulin resistance score) is optimal as is my adiponectin (which I have found low levels of this are associated with IR and T2D - http://care.diabetesjournals.org/content/26/8/2442). In addition, my insulin level is low. This is not unusual for someone who is not IR, but is on a LCHF diet. Meanwhile, my fasting BG (at at the time of the draw, I was roughly 17 hours fasted) is high, my A1c is high and my GSP (kind of like an A1c that only covers previous 2-3 weeks) are high.
I really wanted to post these primarily because I feel like most doctors out there run the most basic of tests and then assume everyone falls into the "norm" which is not always the case. Both my GP and Endo flat out stated I was IR because that is the normal reason someone becomes T2D despite the fact that I had never been obese and at the time of diagnosis was within 10-12 lbs of my ideal weight. I can't stress how important I believe it is to make sure people find a doctor who is willing to look at everything to determine what the true cause of the problem is.
Everything I was originally told by the doctors was how to become more insulin sensitive including taking metformin, HIIT exercise, etc. Now that I know insulin sensitivity is NOT my issue, I am able to focus on those items which appear to be my issues - stress management and some micronutrient deficiencies. If I had not fired my doctors, I would still be working on the wrong things and getting more and more frustrated about not making any progress.9 -
Awesome.
... I want your doctor.5 -
Wow!! Me, too.
Which company did the genetic testing?1 -
I am not diabetic, but am a firm believer in how stress and cortisol release affect weight gain/weight retention. I think that was the biggest player in my latter military years when I was called upon to do command duty more and more. Everyone thought I handled things so well, but what they saw was the part of the duck above the water...floating easily...they didn't see the feet under the water paddling frantically.
I am celebrating the holidays with family and tho I am eating very little, I am losing little...all do to stress. I left KS in -20 degree temps knowing pipes, pumps and tanks were frozen in my RV. I finally thawed out enough on destination to diagnose water pump was the only damage. Had to wait several days for repair (normal due to holiday) and that was extremely stressful. I know my calorie count has been only 400-600 per day but I am not losing anything because of the stress.
I have now washed my dishes and am looking forward to several warm showers (and leg shaves...sorry if TMI) now that water is flowing again. I
I wish I could meditate well, but sitting quietly is very hard for me. I will take several walks with my dog instead.
Happy New Year Everyone! Thanks for being here for me!2 -
