Friday, January 11, 2013

MY OWN diabetes prevention program

This little story caught my attention, and I am surprised that it didn't reach the radar of others, like Eades, who follow the news feeds pretty well.

Now it is this type of article that brings out the libertarian in many a low-carber.  Seems that the diabetes prevention program, based on a clinical study program of the same name, "proves" that their preferred lifestyle modification is superior to doing nothing.  Is it superior to a low carb plan?  Hmmm, I guess with these people in charge, we will never know.  The really sucky thing is that now, as a taxpayer, I'll be forced to fund this make-work-program-for-registered-dietitians as it gets implemented throughout the entire Obama-care-o-sphere.

Seems like these researcher folks have proved that intensive one-on-one "coaching" and united-front eating recommendations have helped people.  But I think I can do better on low carb.

Here's the 5th arm of the study.  (n=1)

I followed a lowish carb diet (no more than 150 grams on most days, even though I tried to shovel it in).  After a couple of months, I went lower carb.  By 6 months in, I had lost 17 percent of my body weight.  After one year, I had maintained most of that weight loss, and was in at 15 percent overall.  During the second year, I quit exercising regularly.  During the third year, I started progesterone and went off regular use of my appetite-destroying sleep medication and was on a good LC diet only about half the time.  My weight did go higher, but the overall weight lost was still above 7 percent.  That 7 percent was the aim of the study.  The folks in the lifestyle intervention arm did lose 7 percent of their initial weight, but gained much of it back, even though they were attempting to follow the diet program and still exercising 100 minutes a week.  The metformin group lost 4 percent, but gained it all back by 2.8 years.

Here's a little table showing the percent weight lost with the treatments across time.

treatment group              6 months        12 months        28 months      33.6 months
lifestyle intervention           7 %                  7 %                                       4 %
metformin only                                          4 %                                        0 %
control                                                      0 %                                        0 %
ME!                                 17 %               15 %                7 %

So here's what I am going to do.  I am going to exercise my "restart" as outlined in the diabetes prevention program.  Let's see how well I do by 33.6 months.  Even though I have not been diagnosed with pre-diabetes, at the start of my lower carb diet, by fasting bg was 101 and my HbA1c was 5.8.  I think those numbers are high enough to take action.  Both numbers were better after a year, but I haven't gone to the doctor or taken any type of test since, except for blood pressure at the blood donation center.  My blood pressure has continued to go down, as well as my waistline, despite the weight gain.

I am only showing out to the 2.8 years, because at that time, the study was stopped and the control and metformin groups were offered the lifestyle modification, and I haven't gotten out that far either.  What I found really interesting is that when they compared the weight loss 10 years out between groups, they broke it out by age. (Go to this study and check out table 2.) The group similar to mine (C and G) had weight losses of diddly-squat over the entire time span.  I bet I'll do better.  I think Dr. Gardner's study showed that the low carb diet did better for women in my age group than the other types of diets.

Stay tuned!

25 comments:

  1. EB-

    All the studies show that the person who loses meaningful weight and keeps it off for more than a year is a statistical outlier. My goal is to be an extreme statistical outlier.

    I think you are very smart to focus on HbA1C as a meaningful marker. Read Hyperlipid's post on "Sweet Heart Disease" discussing the EPIC trial and the death rates of middle-aged people at different HbA1C levels. It is in my top 5 of inspiring writings on diet and nutrition.

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  2. Franklin, I don't believe I am an outlier. I think that I am just someone who won't quit, and I keep trying to make things better above and beyond tinkering with macronutrient ratios, and I am vocal. I do not think I am a special snowflake, I think that unfortunately, I am the norm for women my age. And, it pisses me off so much that everyone is ignoring this, that I just keep wanting to get louder and louder.
    THIS study showed that people can keep it off, at least for a few years, but the problem is that they compare only to metformin and standard SAD-with-a-lecture, not to a low carb diet. Dr. Gardner showed that those wonderful group C women tending towards metabolic syndrome do much better on low carb. Why can't he get this published???? Why won't anybody pay attention to this?????
    I'm going over to the-Hype right now to find that article. Dr. D has been the first health blog I have followed, and always my favorite.
    BTW, my HbA1c went from 5.8 to 5.4 after a year on lower carb. ding ding ding ding!!!!!

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  3. here it is!!!
    http://high-fat-nutrition.blogspot.com/search/label/EPIC%20HbA1c%20and%20heart%20attacks
    An epic post indeed

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  4. What I mean by outlier, is that standard dietary advice (even looking at a decent study like Gardner's A-to-Z) has an effectiveness of about 5-6 months, with most people trending back up after that and a success rate of 1% (if you want to look at meaningful weight loss at one year) and people who stick with an effective plan that works over the long term are the exception.

    They are outliers, with results not based on randomness. Plans based on science that actually works can put people in the outlier category.

    I admire the people who have the stick-to-it-iveness to seek out that science.

    Who doesn't want to be in the middle-aged EPIC group with a great chance of being alive in 6 years versus a sketchy chance of being alive?

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  5. @F, I would have probably been in that category as well, if I hadn't stuck with it and tried the Kruse protocols. I lost weight rapidly, but by a few months I felt like crap and was depleted from overexercising. I got a cold that lingered for a month. Afterwards, I could not get back on track. I struggled with Scharzbein for a month, then switched to Rosedale and lost most of the rest of my weight. It took me about 6 months to lose the rest of the weight. Then I went into "maintenance". As soon as I added in some carbs my weight shot up. (And from the plots, it looks like that is the same thing that happened with Gardner's study.) I developed my own strategies for getting myself back into ketosis. Then I started the leptin reset in earnest. I gave up exercise, got more sun, minimized heat-stress and took supplements to fix my adrenals. In the fall I started taking vitamin D. The next spring I started in with cold thermogenesis and started tinkering with a bit of hormone therapy, and I also paid attention to light cycles more than before.

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  6. While I was disappointed that the leptin reset/ct protocol doesn't guarantee a permanent fix, I do feel that while doing it, I am slowly getting better and better. But you can tell by some of Kruse's posts and personal experiments that he hasn't found the holy grail of permanent weight loss. And it concerned me when many of the webinarians started taking a dopamine-enhancing drug. I know Kruse is tinkering to try to increase dopamine. I'll patiently wait by the sidelines until all their N=1's come in, thank you. The trouble with the paleo community kicking out Kruse is that all the other N=1's walled themselves in, and you almost never hear about the people who don't do well on it. Same as you never hear within the paleo community about the people who don't do well. This is sad for the state of knowledge in general, and will put them in the "fad fringe" category permanently, I feel.

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  7. EB, what dopaminergics are they taking do you know? Why does this concern you? Yes those drugs have potential dangers but so does everything. Woo and I and a few others have been experimenting with l-dopa.

    I have come to accept that a low dopaminergic tone is perhaps THE problem in weight loss maintenance. I have no idea what Kruse has said about this as I don't read anything he writes but I think he's right about dopamine being an issue. I say this solely on the basis of my own N=1 symptom watching and reading the literature.

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  8. Oh, I'll have to look it up somewhere. It is something they are taking in the am, but I may be confusing it with another drug that they were taking to reduce blood sugar. It may be the same drug. To me, this was disappointing because I was led to believe that he did have the answer to permanent weight loss. It did not work that way for me, and for others, and I believe that he is continuing to experiment with stuff that will make the weight loss permanent. I do he is extremely interested in the whole dopamine issue, and while I am not an expert by any means, it seems to me that he is already on the high side for dopamine.
    My concern is that as a public health strategy, Kruse's program doesn't work. That is, if the entire obese and overweight population does not have access to expensive webinars, non-standard and expensive testing, and off-label uses of controversial drugs, it can't be implemented. I already know my HMO won't prescribe such things. Sheesh, I can't even get them to order testing for my progesterone and estrogen levels! So, Kruse's program reads "epic-fail" for everyone but the elite, like the Life Extension folks.

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    1. It must be bromocriptine they're taking. It's a dopamine agonist that reduces HbA1c slightly and raises the dopaminergic tone which is low in obesity and post-obesity. How the hell do they get their docs to prescribe it off-label? I don't read Kruse but I arrived at the same conclusion independently that you need to raise the dopaminergic tone if you are to fight off the post-weight loss blues and blahs. I tried to convince someone usually quite open-minded to prescribe it and he wouldn't even entertain the discussion.

      To me, this was disappointing because I was led to believe that he did have the answer to permanent weight loss.

      Brash, neither Jack Kruse nor anyone else in the world has the answer to permanent weight loss because no such answer exists. Kruse can't give you leptin replacement to trick the hypothalamus into thinking you didn't lose weight nor can he induce excess adipose tissue apoptosis which would be the only true permanent solution. He can lie and scam people all he wants but as you said, it's all experimental and you can see he's clearly making this stuff up as he goes along. It's nonsense. Sitting in cold baths and eating seafood all day long is not going to fix obesity which is actually an intractable problem which requires lifelong vigilance to prevent relapse.

      while I am not an expert by any means, it seems to me that he is already on the high side for dopamine.

      Couldn't agree more. Maybe experimenting with self-prescribed dopamine agonists explains his behaviour in part?

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    2. Do you make a distinction between cryotherapy at the docs office and Woo's surgery? Kruse says don't try metal cryotherapy at home, but I think he gave insufficient evidence that the cold tubs do it. That said, there is nothing better for getting back into ketosis after a few days of eating badly than a day at the beach or in the cold tub. If you can get bg's down and then also get a wonderful night's sleep, I don't see a downside to doing it, except that it is not permanent.

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    3. My take on Kruse's whole dopamine issue is that the risk-taking is necessary for survival during evolutionary change that can happen in step-fashion. Survival goes towards those that can change quickly. But, I don't see us changing all that quickly these days (maybe we'll need it later). It is one thing to be bold, it is another thing to continue to want to do the stupid things that filled our youth. It's great to go all Jim Morrison and break on through to the other side, but it didn't work so well for him, did it?

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  9. My other "concern" if you will, is sort of like on Beverly Hillbillies. In one episode, Granny insisted that she had the cure for the cold. She made Mr. Drysdale, I think, go through all sorts of mountain medicine cures, and drink nasty stuff, and at the end says, "Yep, a CURE for the cold! You'll start to feel better in a WEEK TO TEN DAYS!!!!" (This is an epic episode on this side of the pond. Too bad I couldn't find the link.) Likewise, Kruse will have you sitting in the cold and dark swilling raw oysters and in the end maybe it all boils down to getting the same treatment effect as a street drug or a drugstore diet pill.

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  10. But, I need to qualify before the Kruse-h8trs mis-quote me on some drama website, I do think many of his public suggestions have been very helpful for me and I am grateful for Kruse being in the diet territory here to help many of us.

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  11. BTW, can you perhaps tell me why I was lazy and miserable for months on a lower-calorie, lower-salt, sugar-free diet and after one dose of trazodone, I woke up feeling wonderful, jumped out of bed, went for an early walk, had all my week's action items done by lunch? I lost 6 lb of water weight in a couple of days, and was dizzy lots of the time. Food, especially carbs, made me sick when I thought of eating. I forced food down for a few days, and then started craving proteins and fat. Later in the week I woke up at night a couple of times with my heart racing and thinking I was going to die. Then it was a couple of months of hyper-sexuality and weight loss. It couldn't be just from one good night of sleep. My sleep didn't really improve all that much for the first several weeks. IDN, sounds like dopamine to me, but stuff on the internet says traz will make you gain weight. And maybe getting into deep and uncomfortable ketosis at night? A rearrangement of all the hormones? Eventually weight loss stalled and everything went back to normal. I want to find out what happened and do it again for "the last 20"

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    1. Trazodone is not just a sleeping pill, it is an antidepressant accounting for your improved libido, energy and diminished interest in food. It doesn't act on dopamine but most antidepressants don't anyway. Perhaps you felt great after one dose because you got the first night of good sleep in ages. Other issues you describe like orthostatic hypotension, anxiety, tachycardia - they are very common side effects of this drug especially at the start.

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  12. Oh, its cycloset. Here's another blogpost about it.
    http://sunvalleysoul.blogspot.com/2012/11/hormones-fasting-blood-glucose-and-ct.html

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    1. Yeah that's bromocriptine quick release.

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  13. ....but I didn't get a very good night's sleep....did I?.... I was taking only 12.5 mg, half of the sleep dose, and from what I have read that shouldn't be enough for depression. Since my experience with traz, I have experienced some of the same hormonal changes (eg. get-up-and-go, libido, etc.) when starting DHEA, cold thermogenesis and progesterone, although not as pronounced. Trouble is, taking too much DHEA or progesterone or with too many carbs when overboard into skin problems and pms-like symptoms. I haven't gone overboard on CT yet to see what it will do.
    Honestly, I never would have continued on my low carb journey if I had thought for a minute that all my weird symptoms weren't due to the trazodone. Many of the initial symptoms are the same as going on a low carb diet. It was a tough couple of weeks for sure, and only endurable because I was losing so much weight. I can't believe that at the time, I was still monitoring my SALT intake!

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    1. OK, I take back what I said. 12.5 mg of trazodone is nothing and likely did not cause any of that. Your symptoms like the 6 lb fluid loss, heart palps, anxiety, feeling like you're going to die were more likely due to sodium restriction (and resulting Mg and K depletion) which is one of those CW wisdom things so deeply ingrained in us but actually mortally dangerous on a VLC diet. There have been fatalities from sudden cardiac death secondary to electrolyte imbalances on LC diets. I do remember a decade ago at the heyday of the Atkins diet reports appearing in the British newspapers about teenage girls dropping dead in the middle of the school day, stuff like that. Probably underlying undiagnosed conditions but still. The problem is that medicine is clueless about the nature of a healthy diet and NOBODY - and I mean nobody - warns you when you start dieting to supplement everything and you are even told, idiotically, that as part of a healthy diet you should cut salt. Yes, if you are really unlucky, you might end up in v fib as a result and die.

      It is good that you believed at the time that it was trazodone causing your symptoms but it's time to let go now. ;)

      Yes, I can see how taking DHEA and progesterone would make you feel and look, well, crap. Personally, I don't take any hormones but I do accept that the situation is very different post-menopause.

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  14. how do you raise dopaminergic tone w/o a prescription? It is very easy to get stuff prescribed here off-label, as long as you don't have an HMO. I think those that got it did so because they were able to convince their docs that they had tried lots of other things to lower bg's that didn't work. I know Kruse was working on a way to do it w/o a prescription.

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    1. Well, check out Woo's posts on dopamine. She thinks l-dopa from a herb called mucuna pruriens. Also, you could try amino acid precursors to catecholamines like l-tyrosine and dl-phenylalanine. Careful if prone to anxiety/insomnia. Very stimulating. I can't hack very much of that stuff at all.

      One could also visit one's GP and say they are feeling a bit gloomy and unmotivated lately. When offered an SSRI, one could say one has heard bad things about them and that one's libido is low to begin with so no thanks. One could say that one would like a drug that will increase libido and help lose a bit of weight to which the doctor replies, ok here's Wellbutrin. The patient walks away from the consult with a norepinephrin and dopamine reuptake inhibitor.

      Speaking in generalities.

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    2. ha ha, not going to happen like that here. I hate those people :-)

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    3. btw, do you know what could possibly explain why on day 2-3 of the traz and not eating, I got a nosebleed and a couple of cuts that wouldn't stop bleeding. Weirdest thing, and then left as quickly as it came on.
      I'll tell you, it was a weird several weeks, but I didn't want to tell the doc everything, I wanted to lose more weight first. ha ha

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    4. Were you supplementing a lot of omega 3?

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  15. no, I think at the time I was taking Dr. Oz recommendations, just one cap a day.

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