We are pleased to announce that as of March 4, 2025, an updated Rich Text Editor has been introduced in the MyFitnessPal Community. To learn more about the changes, please click here. We look forward to sharing this new feature with you!
Interesting Dr follow up with LCHF friendly doc for T2
Replies
-
-
1
-
I'm game. A bag of gummi bears says 5.1!
3 -
MyriiStorm wrote: »I'm game. A bag of gummi bears says 5.1!
Not those Haribo SF gummi bears that could coax diarrhea out of a statue, I hope!4 -
I am a little envious of these numbers. When I have my next appt in July, I am hoping for an A1C under 6. The MySugr app says 5.5 now. If I could have it in the mid 5's I would be very happy. I want to lose another 8 pounds by then too. I am working all this. Today was a good day for glucose numbers, so that is encouraging.5
-
I am a little envious of these numbers. When I have my next appt in July, I am hoping for an A1C under 6. The MySugr app says 5.5 now. If I could have it in the mid 5's I would be very happy. I want to lose another 8 pounds by then too. I am working all this. Today was a good day for glucose numbers, so that is encouraging.
Ahem. Your progress would be the envy of just about every T2 diabetic since BG tests were invented!
3 -
Ahem. Your progress would be the envy of just about every T2 diabetic since BG tests were invented!
The response of my bg to the lchf diet has been dramatic. That is a fact. I really felt helpless when I first got my diagnosis. I was following the Diabetes Association diet recommended by my doctor, and it was just not working. I was somewhat desperate and grasping at straws. I found lchf, and the numbers came down almost immediately. It was pretty clear to me that this WOE was going to be part of the solution for me.
I just want them to come down some more and be a little more predictable. I am impatient that way. I just have to lose some more weight and keep working with the lchf.2 -
I had the first follow up this morning. Since today was the day for the blood draw, I wasn't really expecting to spend much time with the doc. To my surprise, I got a full 20 minutes or so with him.
Here is the shock. It was a quality discussion where it was obvious he had actually reviewed my file and previous results and was able to have a quality discussion with me regarding my questions. Given the number of pages of test results I had gotten previously, it would have been near impossible to go over every last result at that time, so focus was on the items where he felt I would get the most benefit.
This time, he verified we were on the same page as to which tests we wanted to see this time and going over both those previous results that were deemed top of the list as well as those where I had questions after doing research on things I had not heard of before.
It was so weird for me to ask a question about a result and have him say something along the lines of, "given your previous results of XXXX..." while grabbing the file to flip to that page. I am use to the doctor needing to look at the folder first, search for the test and then him-haw through a half-baked response - IF he was even willing to spend that much time with me.
Because of some of the testing I am having done requiring culturing, my follow-up isn't until June 13th.
One tidbit I learned today was regarding B vitamins and magnesium. I knew both were required for carbohydrate metabolism, but they are also both required for fat metabolism. However, neither are required for protein metabolism. Therefore, my status of borderline deficiency in most B vitamins last time and actual deficiency in B12 could have been preventing me from properly metabolizing carbs and prevented me from being fully fat adapted and pushing my body into higher BG through GNG.
I am interested to see the results of the vitamin testing this time after 6 months of supplementing. Unfortunately, blood levels are not the most accurate way of measurement of B vitamins as your body will keep those levels up at the expense of what is in the various tissue cells.
Depending on results this next time, I may have to breakdown and get a blood ketone meter to see if I am properly metabolizing fats to ketones.
Sorry for the long follow up post here, but I just found this appointment much more interesting and informative than I expected.8 -
It's immensely gratifying, isn't it, when a Doctor actually talks to you, rather than at you...?
To find a medic who not only reads the paperwork, but knows his/her stuff AND is open to discussion, is like finding the Holy Grail....!5 -
AlexandraCarlyle wrote: »It's immensely gratifying, isn't it, when a Doctor actually talks to you, rather than at you...?
To find a medic who not only reads the paperwork, but knows his/her stuff AND is open to discussion, is like finding the Holy Grail....!
Yes it is. This is the main reason I started this thread. We have no problem changing brands of shoes or changing stores or whatever if we are not satisfied. However, too often we go to one doctor one time and feel like we have no choice but to listen to what s/he says.
I fired both my PCP and my Endocrinologist because they were stuck in dogma from the 80's. I found this guy because he was both on the list of low carb doctors on Jimmy Moore's site and he was actually interviewed on an episode of The Livin' La Vida Low Carb show 2-3 years ago.
Your first appointment with a doctor should be like a job interview for him/her. You are the employer. YOU get to decide if you will continue going there. YOU are the boss. Even if you do continue, the doctor is the equivalent of a consultant, not a god. The doctor gives recommendations on what to do. It is YOUR life. YOU get to make the final decision on matters that affect the one life you get on this earth.2 -
Sadly, it doesn't quite work that way in the UK.
You have a choice of Clinics, provided they are within your post-code catchment area. And it is very frowned upon to have more than one doctor, if they're from different clinic practices.
When you book an appointment with a clinic, unless you make a distinct specification, it's anyone's guess who will see you for your appointment; it could be any one Doctor registered at that practice. What's more, depending on what you need, you may not even get to see a Doctor; you might meet the Practice resident Nurse.
If you want to change Doctor/practice, you have to apply at a new clinic and they will request your Medical records from your previous practice. There's nothing stopping you from doing that - it's your choice. But it does get to look a little suspicious if you make a habit of it....
Doctors do not criticise one another. They might criticise an action, a decision or an MO. But person-to-person? Rare.
This is the NHS. It is by and large Government-supported and mostly funded. Hence, you don't always get what you want. Or need, even. (There's a 2-and-a-half year waiting list for a hip/knee replacement op....)
If you really want to let your hair down and go mad, then you have to go 'Private' and pay, or have good Personal Health Insurance.
That's not to say great Doctors do not exist within the NHS. They do. I have one, and she's an absolute diamond.
But sadly, in many situations their hands are tied by regulations and restrictions, mostly governed by funds (or a distinct lack of them...) and they have to 'toe the line'.
Fortunately, some of them know how to work the system for their patients.
3 -
cstehansen wrote: »One tidbit I learned today was regarding B vitamins and magnesium. I knew both were required for carbohydrate metabolism, but they are also both required for fat metabolism. However, neither are required for protein metabolism. Therefore, my status of borderline deficiency in most B vitamins last time and actual deficiency in B12 could have been preventing me from properly metabolizing carbs and prevented me from being fully fat adapted and pushing my body into higher BG through GNG.
I am interested to see the results of the vitamin testing this time after 6 months of supplementing. Unfortunately, blood levels are not the most accurate way of measurement of B vitamins as your body will keep those levels up at the expense of what is in the various tissue cells.
@cstehansen - Out of curiosity, did he give you the optimal ranges for those vitamins? And which tests should be run to determine them? I ask, as I'd finally tortuously gotten my B12 up from 365 to 835 before it started dropping again to 690 six months ago. Had I not been sick last week, I would have retested then...but I've no idea what it's doing now. To top that off, I'm back on Glucophage for 3 months or so now AND I accepted the free B12 shot offered at our Wellness Clinic at our office last week. And I could tell when I was dipping low again (various symptoms always relieved by a dose), as I'd been doing a B12 lozenge about every other evening with dinner to round out my day... Oh, and did he say anything about how much stomach acid was needed to digest B12? I've only recently discovered that it's quite a lot...
So, TL;DR - Did he give you optimal ranges?0 -
@KnitOrMiss, Selfhacked.com has detailed articles on the vitamins, hormones, and many other lab tests.
Articles here: https://selfhacked.com/articles-joseph/
There's also a reference summary you can have emailed to you. https://selfhacked.lpages.co/leadbox/1457ed5f3f72a2:162a0c68eb46dc/5719721496281088/
1 -
@RalfLott - that's a lot of science there! I looked for B12 and didn't see it anywhere, and I'll admit, I got somewhat lost within just Ferritin/Iron... I'll have to look when I have more time. Thanks for the links.0
-
KnitOrMiss wrote: »@RalfLott - that's a lot of science there! I looked for B12 and didn't see it anywhere, and I'll admit, I got somewhat lost within just Ferritin/Iron... I'll have to look when I have more time. Thanks for the links.
Mind you, there are points you can quibble with in the large amount of info presented there....0 -
KnitOrMiss wrote: »cstehansen wrote: »One tidbit I learned today was regarding B vitamins and magnesium. I knew both were required for carbohydrate metabolism, but they are also both required for fat metabolism. However, neither are required for protein metabolism. Therefore, my status of borderline deficiency in most B vitamins last time and actual deficiency in B12 could have been preventing me from properly metabolizing carbs and prevented me from being fully fat adapted and pushing my body into higher BG through GNG.
I am interested to see the results of the vitamin testing this time after 6 months of supplementing. Unfortunately, blood levels are not the most accurate way of measurement of B vitamins as your body will keep those levels up at the expense of what is in the various tissue cells.
@cstehansen - Out of curiosity, did he give you the optimal ranges for those vitamins? And which tests should be run to determine them? I ask, as I'd finally tortuously gotten my B12 up from 365 to 835 before it started dropping again to 690 six months ago. Had I not been sick last week, I would have retested then...but I've no idea what it's doing now. To top that off, I'm back on Glucophage for 3 months or so now AND I accepted the free B12 shot offered at our Wellness Clinic at our office last week. And I could tell when I was dipping low again (various symptoms always relieved by a dose), as I'd been doing a B12 lozenge about every other evening with dinner to round out my day... Oh, and did he say anything about how much stomach acid was needed to digest B12? I've only recently discovered that it's quite a lot...
So, TL;DR - Did he give you optimal ranges?
That is far more than I can answer now. I can say blood is not the most reliable test because your body will keep blood levels up at the expense of your other cells.
I had read about that a bit from Chris Kresser before. My level 6 months ago was 480 in the blood. Given the amount I have been supplementing, if it is not up significantly, one option is to do a hair test which would show more accurately what is making it into the cells.
Thanks @RalfLott for that link. I will take a look at that as well. I want to be as informed as possible when I go in for my follow up.2 -
cstehansen wrote: »KnitOrMiss wrote: »cstehansen wrote: »One tidbit I learned today was regarding B vitamins and magnesium. I knew both were required for carbohydrate metabolism, but they are also both required for fat metabolism. However, neither are required for protein metabolism. Therefore, my status of borderline deficiency in most B vitamins last time and actual deficiency in B12 could have been preventing me from properly metabolizing carbs and prevented me from being fully fat adapted and pushing my body into higher BG through GNG.
I am interested to see the results of the vitamin testing this time after 6 months of supplementing. Unfortunately, blood levels are not the most accurate way of measurement of B vitamins as your body will keep those levels up at the expense of what is in the various tissue cells.
@cstehansen - Out of curiosity, did he give you the optimal ranges for those vitamins? And which tests should be run to determine them? I ask, as I'd finally tortuously gotten my B12 up from 365 to 835 before it started dropping again to 690 six months ago. Had I not been sick last week, I would have retested then...but I've no idea what it's doing now. To top that off, I'm back on Glucophage for 3 months or so now AND I accepted the free B12 shot offered at our Wellness Clinic at our office last week. And I could tell when I was dipping low again (various symptoms always relieved by a dose), as I'd been doing a B12 lozenge about every other evening with dinner to round out my day... Oh, and did he say anything about how much stomach acid was needed to digest B12? I've only recently discovered that it's quite a lot...
So, TL;DR - Did he give you optimal ranges?
That is far more than I can answer now. I can say blood is not the most reliable test because your body will keep blood levels up at the expense of your other cells.
I had read about that a bit from Chris Kresser before. My level 6 months ago was 480 in the blood. Given the amount I have been supplementing, if it is not up significantly, one option is to do a hair test which would show more accurately what is making it into the cells.
Thanks @RalfLott for that link. I will take a look at that as well. I want to be as informed as possible when I go in for my follow up.
You certainly have taken the bull by the horns!
Just out of curiosity, where do you suppose your new doctor gets his information?
I had a cool experience this week when my local endo had a conflict. I was a little skeptical about seeing the PA instead, but she turned out to be a gem. She's relatively new to endocrinology but brings a holistic, functional medicine perspective. We got to talking about LC and keto, and she actually pulled out a pen and started writing down websites and books I mentioned.
I expect her to have a significant lead on me by my next appointment!2 -
I don't believe all medical professionals are all right or all wrong but I do imagine many roll their eyes after select patients leave the doc's office and pull out this mug:
I'm aware of these cuz I just ordered 3 that read "Please do not confuse your ZILLOW search with my Real Estate License".
1 -
cstehansen wrote: »KnitOrMiss wrote: »cstehansen wrote: »One tidbit I learned today was regarding B vitamins and magnesium. I knew both were required for carbohydrate metabolism, but they are also both required for fat metabolism. However, neither are required for protein metabolism. Therefore, my status of borderline deficiency in most B vitamins last time and actual deficiency in B12 could have been preventing me from properly metabolizing carbs and prevented me from being fully fat adapted and pushing my body into higher BG through GNG.
I am interested to see the results of the vitamin testing this time after 6 months of supplementing. Unfortunately, blood levels are not the most accurate way of measurement of B vitamins as your body will keep those levels up at the expense of what is in the various tissue cells.
@cstehansen - Out of curiosity, did he give you the optimal ranges for those vitamins? And which tests should be run to determine them? I ask, as I'd finally tortuously gotten my B12 up from 365 to 835 before it started dropping again to 690 six months ago. Had I not been sick last week, I would have retested then...but I've no idea what it's doing now. To top that off, I'm back on Glucophage for 3 months or so now AND I accepted the free B12 shot offered at our Wellness Clinic at our office last week. And I could tell when I was dipping low again (various symptoms always relieved by a dose), as I'd been doing a B12 lozenge about every other evening with dinner to round out my day... Oh, and did he say anything about how much stomach acid was needed to digest B12? I've only recently discovered that it's quite a lot...
So, TL;DR - Did he give you optimal ranges?
That is far more than I can answer now. I can say blood is not the most reliable test because your body will keep blood levels up at the expense of your other cells.
I had read about that a bit from Chris Kresser before. My level 6 months ago was 480 in the blood. Given the amount I have been supplementing, if it is not up significantly, one option is to do a hair test which would show more accurately what is making it into the cells.
Thanks @RalfLott for that link. I will take a look at that as well. I want to be as informed as possible when I go in for my follow up.
You certainly have taken the bull by the horns!
Just out of curiosity, where do you suppose your new doctor gets his information?
I had a cool experience this week when my local endo had a conflict. I was a little skeptical about seeing the PA instead, but she turned out to be a gem. She's relatively new to endocrinology but brings a holistic, functional medicine perspective. We got to talking about LC and keto, and she actually pulled out a pen and started writing down websites and books I mentioned.
I expect her to have a significant lead on me by my next appointment!
I can't say for sure where he gets all of it. I know Jimmy Moore interviewed him about 400 episodes ago about a book he wrote about using diet as treatment, so he is not a Johnny come lately to this.1 -
-
I don't believe all medical professionals are all right or all wrong but I do imagine many roll their eyes after select patients leave the doc's office and pull out this mug:
I'm aware of these cuz I just ordered 3 that read "Please do not confuse your ZILLOW search with my Real Estate License".
I had a doctor start googling when I was there once. He pulled up the same page I'd read from. 4 -
I don't believe all medical professionals are all right or all wrong but I do imagine many roll their eyes after select patients leave the doc's office and pull out this mug:
I'm aware of these cuz I just ordered 3 that read "Please do not confuse your ZILLOW search with my Real Estate License".
I had a doctor start googling when I was there once. He pulled up the same page I'd read from.
At least should have used Google Scholar.1 -
I had my follow up today with the results of blood tests and was quite disappointed. Disappointed in the most important result for me which is A1c. Came back at 6.2. So for the last 5 tests were 6.2, 6.2, 6.3, 6.0 and 6.2. The only bright side is I have calibrated my glucometer because I tested with it right before blood draw appointment (107) and right after my appt. (105), and the blood test showed a reading of 106, so I know my glucometer is accurate.
So for the last 6 months I have been taking iodine and b-complex because those were both showing low before and b-vitamins are required to process glucose and fat. Iodine is required for thyroid function which proper thyroid function is required for glucose processing. The result is iodine is now in range but on the low end and all but 2 of the b-vitamins are now good with one just barely low and the other in the borderline range. However, T3, T4, free T3 and free T4 are all still low which would indicate a thyroid issue. So for the next 6 weeks I will be taking a pill for that and following up to see if there is improvement.
I always thought of hypothyroidism as being something that commonly led to lethargy and weight gain. I would consider myself more energetic than most my age, although nowhere near the hyperactive I was when I was young. I assumed the slowdown I have felt was just normal aging. I did know it kept getting harder and harder to not gain weight, but, again, I assumed it was just normal aging, and I never did get THAT heavy only peaking at 223 lbs at 6'1".
On the plus side, my doc understood I had no desire to take a cholesterol lowering drug as my total is 247, but HDL is 78 and triglycerides are only 48. In my mind, from all I have read, those are good numbers with good ratios.
The only other test that came back as a concern was the LpPLA which is a newer measure that seems to indicate cardiovascular risk. It is just up into the borderline area, but it is in the section with other inflammation markers, all of the others are superb like hsCRP of 0.2.
He wrote a script, at my request, to get a calcium score. There is a Groupon deal near here where I can get it for $50, so I will see which way is cheaper as I have an HSA/high deductible plan. I have already met my deductible, so I believe I would only have to pay 20% and regular price is around $200, so that should be cheaper going through insurance.
Although I am bummed about the A1c, I am glad I have a doc who is not just interested in treating that symptom, but he is more interested in root cause and treating it and working with me to do so.
Edit to add: I also found I have a very mild allergy to both peanuts and milk. I had noticed if I ate a lot of peanuts that my BG would frequently be crappy for a few days and I would feel bloated. Those are really the symptoms I think of when I think peanut allergy.3 -
cstehansen wrote: »I had my follow up today with the results of blood tests and was quite disappointed. Disappointed in the most important result for me which is A1c. Came back at 6.2. So for the last 5 tests were 6.2, 6.2, 6.3, 6.0 and 6.2. The only bright side is I have calibrated my glucometer because I tested with it right before blood draw appointment (107) and right after my appt. (105), and the blood test showed a reading of 106, so I know my glucometer is accurate.
T3, T4, free T3 and free T4 are all still low which would indicate a thyroid issue.
Well... according to Dr. Bernstein, thyroid issues are known false inflators of A1c levels (meaning you blow higher than your "true" average). He would also counsel that an A1c is no substitute for your much lower, regular spot BG tests. 1 -
cstehansen wrote: »I had my follow up today with the results of blood tests and was quite disappointed. Disappointed in the most important result for me which is A1c. Came back at 6.2. So for the last 5 tests were 6.2, 6.2, 6.3, 6.0 and 6.2. The only bright side is I have calibrated my glucometer because I tested with it right before blood draw appointment (107) and right after my appt. (105), and the blood test showed a reading of 106, so I know my glucometer is accurate.
T3, T4, free T3 and free T4 are all still low which would indicate a thyroid issue.
Well... according to Dr. Bernstein, thyroid issues are known false inflators of A1c levels (meaning you blow higher than your "true" average). He would also counsel that an A1c is no substitute for your much lower, regular spot BG tests.
I was trying to remember which is worse, BG that is chronically just a little elevated or BG that has significant spikes. My biggest spikes are after the gym and even then rarely go over 140. I seem to just consistently be in the low 100's. The only time I am somewhat regularly below 100 is before dinner and 50/50 right before lunch. Even then, I am talking about numbers like 98 or 99.
What is killer is PP readings at 30, 60, 90, 120 rarely go up more than 15-20 mg/dl from pre-meal - even if I have a higher carb meal, which matches the other metabolic tests showing I process both glucose and fructose better than average and am quite insulin sensitive. It seems to be more of an issue of my body wanting to maintain a homeostatic level over 100. How else can I explain a FBG of 106 with fasting insulin of 4 this time and 3 last time?1 -
@cstehansen - Did the doctor test your Reverse T3? Because that's one of the most overlooked tests. Chris Masterjohn PhD has a podcast (sorry, I don't remember which one) that talks about how you can have a fairly normal free T3 and free T4, and a normal TSH, but still have thyroid disorder.
There are also so many types of thyroid dysfunction. May I ask what pill he put you on?1 -
Oh, and to my understanding chronically high sugars can cause damage long term to your eyes, kidneys, and blood cells, but it is always dramatic spikes/drops that are scarier.1
-
KnitOrMiss wrote: »@cstehansen - Did the doctor test your Reverse T3? Because that's one of the most overlooked tests. Chris Masterjohn PhD has a podcast (sorry, I don't remember which one) that talks about how you can have a fairly normal free T3 and free T4, and a normal TSH, but still have thyroid disorder.
There are also so many types of thyroid dysfunction. May I ask what pill he put you on?
With all the numbers, I forgot reverse T3. It was near the low end of reference which in reality is too low.
As for the med, not sure. It is the generic and just says something like NB thyroid. Pharmacist said take it in the morning on an empty stomach and don't eat for at least an hour. Smallest pill I remember ever seeing.1 -
Most thyroid meds are pretty small. It was crazy, as I had to split one of my meds in half at one point!
I know most thyroid meds have warnings about blood glucose numbers, increases in blood pressure, intolerance to heat, etc., so just be on the lookout. And remember that you can have improvements in labs without improving any symptoms (I know you didn't have the traditional ones)... That was something I hadn't know about when I first started playing this game...
However, by random chance, I just discovered that carnitine can interfere with thyroid uptake... GRR... I at how many conflicts there are within things that are good for other conditions...1 -
It can take weeks or months or even years! for the correct meds or combo of meds to start improving overall "feeling good" feelings, so to speak.1
This discussion has been closed.