Recently, I had an interesting experience chatting with an endocrinologist. I ended up in his office because my health insurance had abruptly switched me to a new primary care physician. I had been taking a medication (Victoza) to try to lower my fasting blood glucose, which had been stubbornly in the prediabetic range for quite a few years. (Edited to add: My former doctor felt strongly that a low-carb diet is what has been keeping me from progressing to diabetes.) My new doctor was skeptical about the wisdom of this medication, and referred me to the endocrinologist. I spent about 40 minutes talking with him. I didn't believe everything he said, but then again, there were some things he said that I would like to believe (and that I think, to be fair, have validity).
My blood lipids are what you would expect in a person following a low-carb way of eating:
- Triglycerides: 62 (normal is under 150, but people who are eating a truly low-carb diet are almost always under 100)
- LDL Cholesterol: 105 (normal)
- HDL Cholesterol: 82 (very good)
I started out by telling him that my goal is to hold on to every beta cell I possibly can. He promptly responded that there is "zero" I can do about that (this, by the way, I don't believe). He also said that in my case he didn't think the results from the Victoza are worth the risks of the possible complications. He said that weight loss could help, and I said I am open to that, but that I pretty much am eating the least I can without chronic hunger. He agreed that I probably would "have to be willing to be hungry for the rest of my life" to sustain further weight loss.
Was that worth it? He made a case that it wasn't. He said that my profile is very low-risk for heart disease, and that probably if I'm relatively fit my obesity is not raising my risk. He went through my health parameters one by one emphasizing how great they are - he was clearly trying to convince me that I'm doing really well, despite the prediabetes. We agreed that I would increase my exercise in amount and intensity (from 30-45 minutes 4 or 5 days per week to 45-60 minutes 6 or 7 days per week, and pushing myself more). He told me to stay away from carbs -- I told him "not a problem, I eat low-carb". ;-) He was glad to hear that, and I told him that my job was teaching people to eat low-carb, and he thought that was great.
I have already noticed that the bump up in exercise seems to be having a mildly positive effect on my fasting blood sugar, but I'm not sure how it compares to the Victoza. Too early to tell.
The doctor also said that when the patients he sees have problems due to blood sugar, they usually have been letting it run amok for quite some time without their paying attention, and that "that will not happen to you". I agreed that it most certainly will not! He said he didn't see any reason to see me again.
Reflections: I do think there is evidence that we can slow down or stop the progression along the diabetes spectrum by paying attention to blood glucose, so I don't agree with the endocrinologist there. I also think that statistically I am at a low risk of both a) complications from blood glucose, and b) heart disease, and that the reason those risk factors are so good is due to low-carb eating. I am continuing to look for ways to lower my blood glucose into a true normal range (at least under 90 for fasting). Right now, in addition to increasing exercise, I am beginning to track my blood ketones (ala Jimmy Moore) and to see what I can do to tweak things. One thing I know for sure from doing this so far -- an hour in the pool (laps and pool exercises) does more than any exercise I've tried so far to improve blood glucose and increase ketones.
I think that sharing our progress (or lack thereof) along the way is an important part of our journey to health, so I hope that my story can be part of this larger conversation.
Photo © Dale Hogan
- Low-Carb Diets and Blood Lipids
- Low-Carb Diets Improve Cholesterol Even Without Weight Loss
- Should Prediabetics Test Blood Sugar?