HAPPY ANNIVERSARY
I’ve just passed the 2nd anniversary of being told that my HbA1c measurement put me in type-2 diabetes territory. Since then, I’ve lost over 30kg, my diabetes is in remission and I’ve spent the summer running 10k as a matter of routine at weekends.
These are big changes and I celebrate them as often as I can. Since being formally in remission, I’ve relaxed my diet a little, but not in any fundamental way. I’m still pretty low-carb and, importantly in my view, the bulk of what I eat is home-cooked from fresh produce or at best minimally processed. I eat more bread now, but it’s generally bread that I’ve made from spelt flour and fresh live yeast or sourdough from a local baker and only rarely supermarket-bought.
By low-carb I mean the avoidance of processed sugars and starches in pre-packaged foods and cutting out completely free sugars, and choosing foods on the basis of their glycaemic index and, later, their calculated glycaemic load.
As I indicated in my last post here (Correlations and Causations, 23rd June), my thinking about what I did that was successful has changed and continues to change. When asked during 2022 and early this year, I would have said that it was my switch to a low-carb diet that was the primary driver of change. I did not follow a keto diet but I did take my cues and some recipes from it, some of which I still use when cooking for the family.
But I did not simply go low-carb, I did other things as well, and as I wrote in that earlier post, I came to the view that it was probably a combination of those factors that was key, perhaps particularly cooking with fresh produce and my deliberate avoidance of what is now known as Ultra-Processed Food (‘UPF’). It struck me last night that approaches based on low-carb and avoidance of UPF at worst have a substantial area of overlap and at best approach identity. They are, I now think, two sides of the same coin. That point has also been made by Dr Kevin D Hall and Dr Chris van Tulleken.
Exercise also had an impact, firstly to assist in ‘burning off’ stored energy, secondly for all round health benefits and thirdly for general body tone, although an unexpected outcome is that my resting heart rate is frequently in the 40 - 50 bpm range and this throws off blood pressure monitors.
The question that is always on my mind, of course, is what to do now to maintain the state I’ve reached? Drs Hall and van Tulleken have both raised a number of issues about, in essence, ‘what works?’ That rather begs the question of what works for what purpose?
I did what I did for a specific purpose, which was to take my HbA1c reading to below the threshold for type-2 diabetes, and in that it was a complete success. The situation is somewhat different today; I’m not now pushing for substantial change, I want now to maintain the change and stay within the bounds of what is - or ought to be - normal for a 64-year old white man in the UK.
I think that focusing on a fresh-food/home-cooked diet and continuing to run (and swim) are the basis of that.
On a broader point, something that I’ve noticed is that the ground appears to be shifting in interesting ways, even over the two years since my diagnosis. For example, there is a growing appreciation that PM25 air pollution appears to be associated with rising hypertension. As a layman, I have no idea how robust that hypothesis is or how far the ground will shift again in the next two years, but I raise it as an example of movement away from purely medicalised accounts of metabolic issues. A shift away from medicalised accounts of cause and correlation may well lead to a shift away from medicalised – for which read pharmacological – ideas of ‘cure.’
My references to Chris van Tulleken are principally to his book Ultra-Processed People, but I also enjoyed a recent lecture currently on YouTube -
I also enjoyed, albeit as a layman, this by Dr Hall -