Morning Has Broken My Blood Sugar No More?

In the past, I commented on how my blood sugar was sometimes significantly higher when I woke up than it was when I went to bed. Going back to my blood glucose readings from 2014 and 2015 (thank you, HealthKit), I can see I had some days where I would go to bed with a reading that was, say, 99 mg/dL, and wake up with a 134 mg/dL reading. I had plenty of days where the reverse was true as well.

I had the impression that I experienced Dawn Phenomenon in the past more often than the data says I did. I also thought it was a thing of the past. Turns out, neither is true. In fact, it's seems I should expect it.

When you eat a low carb high fat diet (in addition to only eating once a day), your fasting blood glucose can be higher! This is because your muscles are fat-adapted and don't need the infusion of glucose your liver pumps out in the morning. Even with that, insulin levels remain relatively low in this case, which is a good thing if you're trying to reverse the insulin resistance that goes with Type 2 Diabetes.

Even if I don't see the blood sugar spike immediately after I wake up, it is pretty common for me to see a somewhat higher blood glucose a few hours later. When my waking blood glucose is generally lower than it was before, the 10-15 mg/DL spike is not quite as concerning. Especially since it's generally lower by the evening, assuming I don't eat anything.

One other interesting tidbit from the above-linked article:

The HbA1c test estimates the average glucose level in the blood over the previous three months by counting the number of glucose molecules stuck on red blood cells. On a low-carb diet the HbA1c will almost always be lower than the FBG suggests, showing that good glucose control, or type 2 diabetes, is not an issue for that individual.

Which means my A1C could actually lower than the 5.2% my 90-day average blood glucose suggests. That would be a wonderful thing as maybe I will get to an A1C of 5.0%, which means I'll be able to go off my meds. I have another month or so before I go in for another set of blood tests, so it will be a while.

Meanwhile, I seem to have broken through my month long plateau. I lost almost 100 pounds or 45 kilos so far. In case you're new to following my weight loss journey, here's how I'm getting there.

My target weight? About 190 pounds or about 86 kilos. At least on the BMI charts, this would put me in the "overweight" category as opposed to the "obese" category I'm in now or the "morbidly obese" category I was in when I started. I can't even remember when I last weighed 190 pounds. Maybe in high school, if even then.

My doctor said he'd like me to see me at about 175 pounds or 79 kilos. Maybe l'll get there, but I've got a few milestones to reach before then. For example, my lowest known weight as an adult, which is only 13 pounds or about 6 kilos away.

Hitting a Plateau, But It's All Good

While I've been progressing nicely with my weight loss, the last six weeks has seen me in Barcelona, Las Vegas, and Bangkok, all for Check Point's CPX360 events. Two of the trips involved significant travel. The result? You might call it a plateau:

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On one hand, I should consider myself fortunate that any weight I gained, particularly in Barcelona and Vegas, was lost fairly quickly--enough that it didn't affect the floating average all that much, which this graph represents. On the other, I'm mildly frustrated to be stuck around the same weight for the last month or so.

Everyone trying to lose weight eventually stalls. It happened to me before when I did Atkins 15 years ago. The difference this time around is I'm aware of it and am using other yardsticks to measure progress. My waist, for instance, is an inch smaller than it was a couple of weeks ago, which has resulted in my clothes fitting a little better. My face? Also seems to be a bit thinner, just from pictures:

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The photo on the left was from late January in Barcelona, the one on the right a couple weeks ago in Gig Harbor.

It seems like I may have broken through the plateau based on the fact my average weight has recently dipped below 235 pounds, or about 107 kilograms. Whether that trend continues or not, I will find out in the coming days.

The real trend I'm concerned about? My A1C number. I won't know for another month or two until I get blood work done again. Still, my blood glucose has been fairly stable with the 30-day average being 105 mg/dL (or 5.8 mmol/L). That suggests I should have a lower A1C than 5.9%, but we'll see.

The good news is that I'm home for the next couple of weeks and the travel I've got planned after that will keep me fairly close to home. This should make it easier to stay on plan and continue to make progress (or at least not lose ground).

I Hardly Recognize You! You Look Fantastic!

I've been hearing variations of this over the last few weeks as I've been doing Check Point's CPX360 events in Barcelona and Las Vegas. For many who had met me previously, it's the first time they've seen me since I've started eating once a day, intermittent fasting, or whatever you want to call it.

And yes, the difference a year makes (or in some cases, only a few months) is quite striking, as these two pictures from roughly a year apart show:

Jan 2017

The above was me at Check Point's Sales Kick off in Las Vegas in January of 2017. Compare that to me at CPX360 in Las Vegas in February 2018:

Feb 2018

For those not keeping track, I'm about 90 pounds or 40 kilograms off my high water mark. My Type 2 Diabetes and high blood pressure are also significantly improved as well.

I posted these before and after pictures on LinkedIn. The response was overwhelming: more than 600 likes and over 70 comments as of this writing!

There is a lot of conflicting advice about how one can achieve these goals. Not only that, you have multiple industries that benefit to the tune of billions of dollars a year from maintaining the status quo. Trying to find your way through all that to something that works for you is...not easy to say the least.

For me, it has boiled down to the following five rules:

  1. Dietary fat is your friend.
  2. Sugar (real or fake) is your enemy.
  3. The less frequently you eat, the better.
  4. When crossing timezones, don't eat until you reach your destination.
  5. Get enough sleep.

What are these rules trying to achieve? It boils down to reducing the amount of insulin my body produces, both in terms of amount and frequency. This is because, as a Type 2 Diabetic, I have become insulin resistant, meaning my body must produce more and more insulin to achieve the same results.

While insulin is needed to metabolize the food you eat, too much of it in your body is clearly a bad thing. Since practically everything you eat invokes an insulin response, the only way you can reduce the frequency of insulin spikes is reduce how often you eat. To reduce the size of the insulin spike when you do eat, the best approach seems to be eat more dietary fat and little to no carbohydrates.

Not eating while traveling long distances is as much about reducing exposure to potentially bad dietary choices as much as it is about resetting my circadian rhythm. I can't claim it's a total cure for jet lag, but it definitely makes jumping a large number of timezones easier. The fact it also supports my larger health goals is a definite bonus.

What about sleep? Lack of sleep contributes to insulin resistance which is a bad thing. The good news is that I have more time to sleep since I spend less time eating and can thus work through breakfast and/or lunch.

Notice I have not put any strict guidelines in these rules. That's because the exact mix that works for me today may not work for me tomorrow and I may need to adjust. Also, the particular mix that works for me may not work for you.

For those who think I am starving myself by only eating once a day (or less), the reality is: I'm not. I've just finally gotten my body to a point where it is able to metabolize the food I previously ate and stored as fat, of which I still have plenty, even after losing as much weight as I have. My energy is better than it's ever been, especially on days where I am active. I sleep better. I'm making better food choices when I do eat (including eating less).

Unlike eating according to a particular diet, which can be difficult to do at times depending on where you are in the world, eating less frequently or even fasting is something you can do anywhere, anytime. Atkins was very effective at lowering my weight back in the early 2000s, but I found it very difficult to maintain, particularly as I started traveling more. When I stopped that way of eating, I gained more and more weight. I eventually started having health issues that ultimately led to a diagnosis of Type 2 Diabetes.

Now, when I do find myself in a place I've never been before, I don't feel guilty about trying the local food. Or, in the case of a celebration, I can indulge myself occasionally. Because, let's face it, life is going to happen.

After it does, I can get back to eating once a day. Maybe even fast for a couple of days to reset things.

The bottom line: I think I've found a lifestyle that works. I spend a bit more on coffee now (black or espresso), but I spend a lot less on food. I will eventually have to buy a new wardrobe, though clothes I haven't worn in years now fit again. I feel like a different person.

A few resources I've used in my health journey:

I'm by no means where I want to be, but I'm definitely in better shape than I've been in more than a decade!

The Annual Physical

Yesterday, I went to visit my doctor for my annual physical. The doctor made a few observations:

  • I'm at my lowest weight according to their records, which go back to 2009. He actually asked if I had weight loss surgery when I told him on my last visit what I was doing. Apparently my chosen lifestyle didn't make his notes, nor did he consider that I'd probably consult with him before doing that.
  • My diabetes is improving as my A1C went from 6.5 to 5.9. He even said I might beat it. It's certainly my goal to to beat it, but I also know it's not going to happen overnight either.
  • I am no longer "morbidly obese" according to the guidelines, I am just "obese." Guess that's an improvement.
  • I should probably set my weight target at 175 pounds (or a little under 80 kilos). Right now, I am aiming for 195 pounds (or about 88.5 kilos) and I'm still a ways off of that.

Meanwhile my weight loss progress had a bit of a setback after my recent trip to Barcelona, both due to the excellent food and wine, and the fact I brought back a cold. However, I am not worried about this regression as the path forward is clear, but more importantly, sustainable.

Victories Not Quite To Scale

From my last update about 6 weeks ago, I have made more progress at lowering my weight and improving my Type 2 Diabetes:

  • Weight: 245 pounds/111 kilos, about 80 pounds/36 kilos under my high water mark
  • Blood glucose (30-day average): 106 mg/dL or about 6.0 mmol/L
  • A1C (from blood test in late December): 5.9%

I can blame the higher blood glucose on the holidays, but then again, the A1C number is a bit higher than I was predicting based on averages around that time. Either way, the A1C is a trailing indicator that is still trending in the right direction.

I still need to buy some new clothing, but I'm putting it off as long as possible since I expect to shrink a little more. Meanwhile, a particular hoodie that I acquired two years ago and haven't been able to wear until fairly recently is still not quite big enough for my wife's tastes. The fact I can wear it at all is another one of those non-scale victories I've been having as of late.

My next doctor's appointment is in 3 weeks. Curious what he will think of all this. Even though he's not totally onboard with my regimen, the transformation that has occurred in the last 8 months is pretty dramatic. Compare my passport photos from March 2009, June 2008, and June 2017:

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To a few days ago:

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Non-Scale Victories, the Been There, Done That, Got the T-Shirt Edition

Continuing the non-scale victory discussion, I've heard one suggestion for tracking your progress that does not involve a scale: try on an article of clothing on periodically to see how well it fits. Specifically, an article of clothing that is too small.

Given that my team is ordering t-shirts for our upcoming Check Point Experience event, it seems like a good opportunity to acquire some. These shirts were ordered from an outfit in Israel that often makes their shirts small by American standards. That makes these shirts excellent candidates to track non-scale victories.

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The good news is that the largest shirt they ordered fits, but is a little small for my tastes. About what I expected given the equivalent size of a typical American shirt fits just about right.

Non-Scale Victories

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While I've had plenty of victories on the scale, such as managing to lose four pounds on my most recent trip to the New York and Philly area, as the above picture will attest to, I've had my share of victories that don't show up on the scale, but are the result of attempting to lose weight.

One such non-scale victory is the comments I've been getting from people. My current job has me in public a lot more than I used to be and people that saw me even six months ago are noticing that I've dropped a significant amount of weight--about 75 pounds (or 32 kilos) worth!

Another is something that people don't realize is an issue for people of size when traveling on an airplane--seat belt length. On just about every flight I've taken in the last 15 years, I've had to ask a flight attendant for a seat belt extension. As there is quite a bit of variance when it comes to equipment on airplanes, I still have to ask for one occasionally, but it's not an every flight occurrence anymore.

Yesterday, I tried on the one pair of pants I still have with a 44 inch waist--and they fit well. Granted, these have stretchy sides, since I got them from a big and tall store, but they aren't a tight fit, which means: they'll work. I tried on a few shirts from my "skinny drawer" and discovered they fit well enough to wash them and hang them up on my closet. Meanwhile, there's two shirts I left in my "skinny" drawer that, after I lose some more weight, will be a better fit.

Meanwhile, all but one pair of pants I own are now too big for me. Some of the pairs of pants I can still wear with a belt, but I suspect even they will be too big before too long. The ones that were much too loose were put in place of the shirts I pulled out, making it more of a "fat drawer" than a skinny drawer now.

My blood sugar, meanwhile, had a minor setback with my time in New York, both because of some good beer and some good sushi! That said, it's a blip in the short-term average, with my longer term average still excellent. Hopefully I get a much better idea with a proper blood test, which I need to do in the near future so I can schedule an annual physical with my doctor.

A non-scale victory to come will be when I can purchase clothes for myself in a non "big and tall" store. That would imply getting down to maybe a 38 inch waist. Even when I managed to lose weight with Atkins more than 15 years ago, I never quite managed to achieve that goal. This time, I'm more determined to get there!

Intermittent Fasting, 6 Months Later

It’s been roughly 6 months since I began Intermittent Fasting, which I began after reading The Obesity Code by Dr. Jason Fung. Within the last month or so, a research journal called Obesity published an article entitled Flipping the Metabolic Switch: Understanding and Applying the Health Benefits of Fasting that discusses the health benefits of adopting intermittent fasting, complete with citations to other medical journals.

With that as a background, it seems like as good a time as any to document my progress. First, my stats from May 2017:

  • Weight: 311 pounds or 141 kilos, which is about 15 pounds below my high water mark from 2016
  • Blood Glucose (30-day average): 137 mg/dL or 8 mmol/L
  • A1C (based on a blood test): 7.1

The desire to try intermittent fasting got further spurred on by the basic message I got from my doctor in May of 2017, which was that I wasn’t making any progress in terms of controlling my diabetes. The doctor was, of course, correct. When I was diagnosed back in October 2014, my A1C was a 7.9. In May of 2015, I had gotten my A1C down to a 6.1. Clearly things were trending in the wrong direction.

With this as a backdrop, I made a number of changes to my eating habits gradually over the last six months:

  • Went from 3 meals a day plus snacks to 2 meals a day to 1 meal a day to 1 meal every other day. The step to every other day just happened in the last 2-3 weeks or so.
  • When I do eat, I try to pick things that are ketogenic friendly (i.e. high in fat, moderate in protein, low in carbs).
  • When I travel by airplane, I do not eat in the airport or on the airplane, eating dinner at my destination. This helps reset my circadian rhythm and provides an excellent opportunity to fast.
  • I went from drinking coffee with heavy cream to black coffee and espresso shots. When I get my free drink at Starbucks, I will get a Latte with Heavy Cream. I will sometimes also have vanilla herbal tea with heavy cream after dinner sometimes also.
  • Once or twice a day, I will have a cup of broth for the electrolytes

Note the above guidelines are not adhered to strictly. They are varied based on life circumstances and social obligations. Which, honestly, is a key to long-term success with any major change you make in your life.

My stats as of right now?

  • Weight: 256 pounds or 116 kilos, about 70 pounds or 32 kilos under my high water mark
  • Blood glucose (30-day average): 99 mg/dL or about 5.6 mmol/L
  • A1C (estimated based on 90-day average, will do a blood test in a few weeks): 5.4

All of those stats are definitely trending the right direction.

For Those Asking What I’m Doing To Lose Weight

It’s pretty simple:

  • One meal a day (personally I strive for a low carb, high fat meal, but this isn’t strictly required)
  • During fasting periods, I drink water, black coffee/espresso, tea, and/or broth
  • I mostly avoid artificial sweeteners
  • For long flights, I fast the entire time in transit and eat dinner at the normal time for destination (or skip entirely)
  • I also pick a day during the week (usually Sunday) where I consume less than 500 calories for my “meal” (or skip it entirely)
  • Get enough sleep (for me, about 7-8 hours)

I did not just jump into above “cold turkey” but gradually worked my way up to these guidelines. I expect they will further evolve over time.

For those who think fasting is hard, there is some initial difficulty as your body adapts. Some refer to this process as “keto flu.” It does get much easier.

I do make allowances for “life events” and will occasionally vary from these guidelines. For example, when I was in Ireland, you can bet I drank Guinness outside of a normal meal period. I plan for these events and adjust accordingly.

The benefits I’ve derived from the above include, but are not limited to:

  • Weight loss (averaging 1-2 pounds a week, but it varies from week to week)
  • Lower blood glucose readings (a good thing as a Type 2 diabetic)
  • Food cravings are mostly gone
  • Little to no jet lag (even when I jump 9-10 time zones)
  • More time during the day (because meals take time to have)
  • Lower grocery bills
  • Better sleep

The above appears to be working for me and may or may not work for anyone else. Do your own research and come to your own conclusions by typing the following terms into your search engine of choice:

  • Intermittent fasting
  • Ketogenic diet
  • Dr. Jason Fung
  • The Obesity Code

Happy to answer questions through all the usual channels.

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