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Thread: Need Type 2 Diabetes Primal Help! page 2

  1. #11
    otzi's Avatar
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    I don't understand why you are so bent on getting him in ketosis. Ketosis is not needed in the least for control of T2D or PreT2D. Ketosis sucks for most men, I tried it several times and could not sustain it. Felt like crap, muscles sore. Nothing wrong with potatoes or rice and fruit--just make sure to combine them with plenty of healthy fats and fiber to lower the glycemic load.

    Pre-diabetes from metabolic syndrome usually goes away when you quit eating junk food and refined sugars and get your weight under control and start exercising. Doing this while in ketosis may actually hamper efforts to regain insulin sensitivity.

    I think you are spinning your wheels here. When you get the tester, play with it a lot. If you have questions about what you are seeing, post them here. Also, get a good set of labs looking specifically at markers for metabolic syndrome (cholesterol, trigs, liver ALT, and other standard labs). Being in ketosis is not the health marker to track! Eating too much protein will knock you out of ketosis as well.

  2. #12
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    to be honest things will be much clearer for him once he starts testing- it really does help you understand your own individual idiosyncracies-we are all different in responses to food.
    i cant eat like otzi for example "Eat lots and lots of fruit, vegetables, and meat. He can eat sugary fruit, potatoes, rice, bananas, and other carby foods--just don't need to go overboard." carby foods increase and keep my BG high, sugary fruits particularly those high in fructose like bananaa are dreadful for me and so are rice and potato. vegetables are mostly good and most of my carbs came from veg while dieting. i also had to eat 4 times a day to keep the smoothest profile- if i left a long gap my blood sugar would drop with a resulting reflex release of glycogen that would push me up to over 200.it would stay there so when i ate next i'd already be high,
    he needs to find what works for him best. for me its between 40-70g carbs 100 -120g protein while losing weight and now i'm maintaining i've stayed the same -just increased caloriesbut i want to stay in ketosis. my aim as you know was always to do this as quickly as possible- i'm at the position now where my fasting sticks around 5 and my postprandials are around 7.
    When I'd had enough of the grain and starched based 'diabetic eating for health' diet (eating for health, my ass!) my weight was 242.5 lbs. On starting primal- 18th April 2013 weight : 238.1.
    27th July 2013. weight after 100 days 136.9 weight lost 101.2lb ; that's 105.6lbs since I stopped the 'diabetic eating for health'
    new journal http://www.marksdailyapple.com/forum...ml#post1264082

  3. #13
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    To the OP: I am a medical doctor and I spend a LOT of my time consulting people like your husband. I am a specialist in eyes, but we do nutritional consults in my office twice a week. Most of my patients are your husband, minus any intervention, in 20 years. In short, they are very sick. Much more so than he will ever be, with your research into this. I will write a lot here because this stuff is what I do....I have a patient coming in at 3:15pm, so I have about a half hour to say the same to you as I likely will to him.

    I always say to my pts that it is about only 3 things: Where you are, where you want to go, how committed are you to get there...everything else is garbage

    1) Where are you?--> Step one is for him to get the following done: HbA1c, 100g glucose test, and a VAP cholesterol panel....I send several PCP referrals a day with these exact things ordered. I am hopeful you won't have to work too hard to get it. The first two are often fully covered as preventative care, the third runs about 100 dollars in most places....this will give you a better idea of his true insulin response and risk-factors. "Whole lipo" labs are meaningless to me. I literally do not even scan them in when I get a new pt that brings them in....you have cholesterol total of 280? Ok, thanks. Tells me nothing. You could be healthy as a horse or a reaper could be following you around.
    --> Next test is a water body fat test to give lean muscle as well as total BF%....then it's picture time. You take 6 photos, you choose the angles and take them yourself...these stay in a notebook that you keep all of your numbers, exercise, and diet in. I tell every new patient to bring a 3 inch binder to the big consult. Anything will work though. I call it "The Book of Life", to be corny, although I had one patient call it "The Book of Lazarus", referencing my nickname here and at work. He was a very sick man and felt like he would be rising from the dead, so I guess it fit!?

    2) Where are we going?

    --> Next you setup 3mo interval follow-ups of all the major labs. This may cost money, but it will provide amazing motivation. The markers to follow are all of your insulin tests, as well as your BF. I usually set markers for when certain incentives will kick in. Usually this is getting off of a medication, free stuff from the office, etc, and these will be up to you. Perhaps your doc will do the same kind of thing....I don't like how most docs practice, so I run my own privately

    3) Commitment. The Plan.
    --> First of all, trying to hit ketosis in a diabetic is not really beneficial. The main problem he has is that there is not an adequate response to his own insulin, and a diet that makes it go through periods of extreme fluctuation, through fasting and gorging, will not help that....the END goal is to be able to tolerate fasting, but we must build up the system to tolerate that....in addition, his mood and affect from doing ketosis will be even WORSE than a normal person, as the "starvation" response, intracellularly, is worse for someone with a problem managing the main storage hormone of the body. I could explain this all, but it would be needless.
    --> The goal should be no more than 50 carbs a day, EXCLUDING all fruit and veg, within reason. Things like rice or potato will have their day, but first you have to slay the beast that is metabolic syndrome...in the interim, these foods will not be helpful, as they often provide rapid glycemic loads he cannot metabolize. Again, the hormone that shuttles all those fast carbs doesn't work for him. You only get short-term toxicity.
    --> Now the hard part, and only your doctor can really supply this....what I do is I have a sliding scale, to where certain benchmarks in the defeat of his metabolic disease lead to higher carb amounts, more exercise, and more fat intake. Using the markers I mentioned earlier, it all does a kind of bell curve:

    1) Strict, near paleo, lower fat, lower carb, frequent meals.
    2) More primal guidelines, more carbs, more fat if needed, a lot of exercise, spaced out meals.
    3) Full primal with some laxness. A lot of heavy weight exercise if possible, fasting.

    Only his doctor would be able to tell when each of these levels is possible and safe. In some patients, not often those that I see however, step one can be left out entirely....in others, step one takes 4-6 months to fully defeat the markers to a territory I like.

    Yesterday morning I saw a 52 year old woman that 16 months ago was 270lbs, HbA1c of 11.5% (terrible), and was on 3 meds including ambulatory insulin for her NIDDM. She had undergone 4 eye surgeries with me.

    Now she is 145lbs, HbA1c of 5.0% (healthy. A full on paleo-athlete is about 4.0% commonly), off all meds, and ran a 5k in Burlington last month....it is all very doable.

    Get the numbers run and report back. PM if you like and I will give more info. I practice in New England if you all are local

  4. #14
    otzi's Avatar
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    Quote Originally Posted by TheyCallMeLazarus View Post
    Now she is 145lbs, HbA1c of 5.0% (healthy. A full on paleo-athlete is about 4.0% commonly), off all meds, and ran a 5k in Burlington last month....it is all very doable.
    I hope lots of people read this response! So many of us are spinning our wheels with the end goal to 'look like Mark Sisson' rather than realistic, health-driven goals.

    You say a paleo-athlete could have an A1C of 4.0, my recent lab sheet showed my A1C was 4.78 with a reference range of 4.8 - 6.0, meaning there was a big 'L' next to my result.

    I'm probably in the best shape of my 48 year life, not quite an athlete, but compared to most of my contemporaries I'm a friggin' Olympic Gold medalist.

    How is an A1C below the reference range a good thing, if I may ask...

  5. #15
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    Quote Originally Posted by TheyCallMeLazarus View Post
    To the OP: I am a medical doctor and I spend a LOT of my time consulting people like your husband. I am a specialist in eyes, but we do nutritional consults in my office twice a week. Most of my patients are your husband, minus any intervention, in 20 years. In short, they are very sick. Much more so than he will ever be, with your research into this. I will write a lot here because this stuff is what I do....I have a patient coming in at 3:15pm, so I have about a half hour to say the same to you as I likely will to him.

    I always say to my pts that it is about only 3 things: Where you are, where you want to go, how committed are you to get there...everything else is garbage
    What % of your patients sign on after hearing the spiel? And what % stick with it to the point of making a significant improvement in their health? It sounds very intimidating.

    I get a lot of questions about how I lost 70+ lbs and recently about how hard it is to keep it off, but when I tell people I actually don't have much willpower, it was more about getting my head in the right place, they respond as if I must be some freak of nature. Exactly two people have been really excited by the thought that getting their head in the right place was all it took - and both of them have lost a bunch of weight. I think my delivery is maybe not convincing enough. Maybe it's not intimidating enough.
    50yo, 5'3"
    SW-195
    CW-125, part calorie counting, part transition to primal
    GW- Goals are no longer weight-related

  6. #16
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    "What % of your patients sign on after hearing the spiel? And what % stick with it to the point of making a significant improvement in their health? It sounds very intimidating."

    To be blunt: I don't think my approach would work with "normal people". I think it works primarily because of who my patient base is.....

    My average patient has been NIDDM for about 20-30 years, often longer. They are sent to me because someone has recommended at least a consult on whether their diabetes has caused so much damage in their eyes that they require surgery.

    In medical-lingo, this is what we refer to as "end-organ damage" of diabetes, meaning that it has begun to compromise actual parts of the body. On some of my patients, this is NOT the only place this has occurred. At least 20% of my patients can no longer walk, have diabetic boots on, are on liver treatments, etc. I don't deal with your normal diabetic. I deal with someone that has, by the numbers, about a 90% chance of being dead in 5 years.

    Not everyone that I see is THIS sick, but a good deal are, others realize it is down the road. I often say that I don't have to do any scary stuff or say much: I just have to give them some graphs of what their situation looks like, statistically....I don't do this, but they know the realities.

    In other words, for many of my patients, literally "change or die". I use those 3 words with probably 60% of my patients. I think I said to a man earlier, "My job isn't to put you on a magazine cover. It's to keep you looking down at the ground instead of up at it." I am not a sexy-maker trainer. I am trying to keep people alive, and if fully successful, on a full turn around.

    So far, I have about an 85% buy in rate. I make nothing by doing the diet part. It is revenue neutral by the time my expenses are paid....but doing it any other way is not responsible, or realistic to me.

    As for success, I have my OWN binder I show them (while they bring theirs). In it are, as of last month when I updated it, 226 names. Most have seen the proof in one form or another. It's not hard to do what I do. You just have to be really, REALLY, honest with people

  7. #17
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    Quote Originally Posted by TheyCallMeLazarus View Post
    To be blunt: I don't think my approach would work with "normal people". I think it works primarily because of who my patient base is.....

    My average patient has been NIDDM for about 20-30 years, often longer. They are sent to me because someone has recommended at least a consult on whether their diabetes has caused so much damage in their eyes that they require surgery.

    In medical-lingo, this is what we refer to as "end-organ damage" of diabetes, meaning that it has begun to compromise actual parts of the body. On some of my patients, this is NOT the only place this has occurred. At least 20% of my patients can no longer walk, have diabetic boots on, are on liver treatments, etc. I don't deal with your normal diabetic. I deal with someone that has, by the numbers, about a 90% chance of being dead in 5 years.
    That's the key, I guess. Seeing your body disintegrate out from under you will get your head in a different place in a big hurry.

    How often do Drs. who deal with "end-organ damage" aggressively address the causes of diabetes with their referrals? I've never heard of such a thing - though I don't personally know anyone who has progressed beyond a prescription for Metformin.
    50yo, 5'3"
    SW-195
    CW-125, part calorie counting, part transition to primal
    GW- Goals are no longer weight-related

  8. #18
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    Quote Originally Posted by TheyCallMeLazarus View Post
    "change or die".
    What my wife (a nurse) said to me.

  9. #19
    TheyCallMeLazarus's Avatar
    TheyCallMeLazarus is offline Senior Member
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    "How often do Drs. who deal with "end-organ damage" aggressively address the causes of diabetes with their referrals? I've never heard of such a thing - though I don't personally know anyone who has progressed beyond a prescription for Metformin."

    I would say not very often. I have found that I have little to no competition in providing nutritional guidance to my patients, and seeing as many patients are VERY interested, it gets me a lot of referrals I wouldn't otherwise get just doing surgery.

    You are actually touching on a very sore spot for me in how modern medicines views NIDDM. I would say that, very generally speaking, it goes like this:

    1) "Borderline" => A lot of times this is the most dangerous, because many times only their fasting BG is being used to make this call. Because of this a lot of underlying, often severe disease progression occurs, often without the patient believing they have to change much. Most docs will do the normal "diet and exercise" spiel, but it lacks much punch.

    2) After Dx, waiting period and metformin => Many docs give metformin as your first line, almost as a rule. Again here though, the tone to most patients is tentative....even when they are young, and would otherwise still have a lot of tools to turn things around. They are told that metformin will handle it, again more generic dieting guidelines, and move on. Many patients stay in this phase for years.

    3) 2nd line therapies => Once the above fails, other meds are added. My this point that tone goes more to "well, you have it. Try to manage it."

    4) Emergent care, insulin, end-organ damage => These are my people....I guess I left out one very big thing about diabetes: generally speaking, it is a time-dependent disease. In short, the longer you have it, the more complications you get. This is true for eyes, liver, kidneys, etc. A 20 year DM has much higher odds of end-organ damage than a 15 year, and so on.

    Now, at what point there was the CAUSE really ever attacked? I mean full out warfare on metabolic syndrome. Not DASH, not a vague guideline, a full on "we are going to defeat this" mentality? The answer is never. The drugs are our crutches, nothing more. Teaching them to walk again is not really taken as the first line treatment, in reality.

    For me, ALL patients showing signs of metabolic syndrome onset, and by that I mean the cascade of toxic effects caused by prolonged states of high insulin, should have doctors that demand complete overhaul of their diets.....the time to do it is THEN, not after 20 years of carnage and my lasers zapping the bleeding in their eyes. A lot of times I am the guy called in the bottom of the 9th inning, down ten runs, with my job being to help them mount a comeback. It's a shame and it's all malpractice in my view, but it is the reality of how it is handled.

  10. #20
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    Quote Originally Posted by TheyCallMeLazarus View Post
    I would say not very often. I have found that I have little to no competition in providing nutritional guidance to my patients, and seeing as many patients are VERY interested, it gets me a lot of referrals I wouldn't otherwise get just doing surgery.

    You are actually touching on a very sore spot for me in how modern medicines views NIDDM.
    ...
    A lot of times I am the guy called in the bottom of the 9th inning, down ten runs, with my job being to help them mount a comeback. It's a shame and it's all malpractice in my view, but it is the reality of how it is handled.
    Well, I hope you are getting considerable satisfaction from the work you are doing, because there are millions more who could use the kind of guidance you are providing and they are screwed by living miles from VT.
    50yo, 5'3"
    SW-195
    CW-125, part calorie counting, part transition to primal
    GW- Goals are no longer weight-related

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