The Story So Far
A note for new subscribers
As I’ve gained a couple of new subscribers, I thought I’d do a condensed ‘story so far.’
Nearly 3 years ago, in late October 2021, my doctor called to say that my fasting HbA1c had passed into the diabetic range – 54mmol/ml (7.1%). By February 2022 I had lost 18kg (40lb) and my HbA1c was 37mmol/ml (5.5%). In April 2023 I had lost a further 10 kg (22lb) and my HbA1c was 31mmol/ml (5%).
At no time during that period or subsequently have I taken any medication for diabetes or weight loss. My type-2 diabetes meets the definition of being ‘in remission’ and that’s what is on my medical record. I am now in my second/third year of remission depending how you count it. I have no foot or retinopathy issues.
A year ago I would have said (and did say here) that the principal cause of the change was a low-carb diet. That is what I thought I was doing when I decided to address the issue by not putting sugars, especially refined sugars, into my body. Now I would take a more nuanced view. It is certainly true that I adopted a low-carb diet, though not a full keto diet, but I also cooked almost everything from fresh and reduced my portion sizes. I did not snack or, if I did, it was on nuts or fruit. I did not, and do not, eat between around 18.30 in the evening and 08.30 the following morning. In time I increased the amount of exercise I do. I also cut out most alcohol for several months.
I paid attention to the glycaemic index and glycaemic load of the carbs that I did eat.
I did one other thing that I now suspect was the single most important thing of them all: I kept a journal and set myself simple targets, notably to get from 38” waist jeans to 28” waist jeans (I failed, I’ve been in 30” waist jeans since October 2022, though I did have to punch new holes in my belt as I slimmed down.)
All of the above approaches are becoming received wisdom, but they were not when I started. And it is true that whatever it was I did worked. But I’m hesitant now to ascribe a single cause and effect; I now think it was the combination of things that pushed my diabetes into remission.
Now, three years on, I’m not trying to beat a diabetes diagnosis, I’m trying to maintain the state of remission. I allow some carbs in my diet, though I still avoid potatoes, pasta and rice, and I’m more relaxed about eating a desert at a restaurant, for example.
To be clear, none of this is advice, just a statement of what worked for me. I am a white man in my 60s in Scotland; what I did may not work for people with different metabolisms or medical conditions, though there is growing evidence that the approach I took works for an awful lot of people. My diabetes went away without any medication by making changes to what I ate. There are issues with that, especially economic and social inequality issues regarding access to whole foods, and I’m lucky to be in Europe where there is not so much crap in the processed food if you have no alternative but to eat it.
These days, I wonder about other things that are likely to crop up here in future. For example,
I avoid rice but there are cultures built on rice as a staple which did not have any historical issues with diabetes. Perhaps it isn’t the rice but the quantity of rice? My experience visiting China was that rice was not served in the quantity it is here. Or perhaps it is the refined nature of the rice usually found here in the west?
One of the problems with supermarket bread and baked goods in the UK is that they are heavily processed. In particular, the industrial bread baking process does not allow enough time for yeast to work on the carbohydrates in the flour and convert them. When I make bread myself I use flour, water and yeast with a dash of salt and olive oil. I allow a long rise to maximise contact between yeast and carbs/sugars. There are no vegetable oils or emulsifiers or other chemical additives. Maybe it isn’t bread as such but industrial bread that’s the problem?
Why does so much low-carb/keto advice sound like evangelism bordering on cultic behaviour?
Diabetes is identified and tracked through blood glucose, but that is a symptom rather than a cause, I think; diabetes is a symptom of an insulin problem. Diabetes is, or appears to be, an outcome of activity in the metabolic system and thus a systems-thinking approach should dominate rather than naïve cause and effect model.
Glycaemic Index and Glycaemic Load were useful guides when I was dealing with the diagnosis, but in retrospect I’m not sure how useful they really are. This is because they reduce foods to a single chemical constituent and do not give any regard to, for example, fibre content or the physiological responses to the act of eating itself, beginning with the action of saliva and chewing.
And so forth.
This is not a high frequency substack and it will remain free. My aim continues to be to publish the occasional post when I think I might have something to say. Feel free to tell your friends about me if they might be interested.