About four and a half months have now elapsed since I began a new diet regime using intermittent fasting and lowering my carb intake. See my previous post for the details on my motivation and some of the theory/evidence behind it.
For the first two month or so of the diet, I fasted for 3 days every week, usually on Thu/Sat/Mon. On the days that I ate, I had two meals, lunch and dinner, between noon and 6PM. Snacking, mostly nuts and dried fruit, were confined to the period between the two meals, but I did indulge in a little candy (mostly gummy stuff) and chips periodically. I did not deliberately try to control my portions and we even went to a few all you can eat buffets during this time. In general, though, I think my portions were smaller than what I had before starting the diet. This implied that each of my fasting intervals lasted roughly 42 hours. In addition, I mostly eliminated diet sodas and sugar free drinks due to their known effects on insulin.
After the first two months, as I approached my initial wight goal, I cut back the fasting to 2 days a week, usually on Thu/Sun. I was also somewhat less strict about not snacking after 6PM. For the most part, however, I stuck to the same regimen.
As for the composition of my diet, I chose not to go the keto route on the carb front since, well, I love rice and pasta so going without was not something I was interested in doing, at least at first. However I did try to cut back, e.g., one bowl of rice instead of my habitual 2 or 3, etc. All in all, I would say I simply changed my proportion of carbs from one that was highly elevated to one that was more normal or typical.
As you'll recall, my main objective was doing something about my diabetes. Last Friday (4/13/2018), I had my blood tested again and the results are in.
Here are the key metabolic measurements before* and after:
| Before | After | |
| 12/11/2017 | 4/13/2018 | |
| Fasting Glucose | 114 | 98 |
| Hemoglobin A1C | 6.6 | 5.3 |
| ALT | 67 | 18 |
| AST | 39 | 24 |
| ALP | 43 | 48 |
| Albumin | 4.9 | 4.9 |
| Bilirubin | 0.8 | 0.9 |
* Technically not before since the reference blood test was done 2 weeks after I began the diet, but close enough.
For the first time since I began getting tested on a regular basis, all of my glucose and liver function numbers are in the normal range. At peak, before I started taking metformin, my A1C was 7.7. Eventually I was taking 2000mg of metformin per day. It helped but my A1C was still around 7.0 or so. My old doctor proceeded to prescribe glimepiride, though I was very reluctant to take it, and only did so with very large meals. After I started fasting, I stopped glimepiride all together and gradually ratcheted down my dosage of metformin. On fasting days I skip it, but tried to take 1000 mg with most meals. On average I am probably taking about 1000 mg per day, since I did not always remember to take it with a meal. An interesting question which I am not ready to try yet is whether my numbers will go up much if I stopped all together. Because there is some evidence that metformin may have positive effects on longevity, above and beyond its ability to control blood sugar, I may continue with roughly this dosage indefinitely. Unlike glimepiride, it does not have the negative side effect of worsening insulin resistance.
My test results were not a surprise, though I had hoped that my fasting glucose would be better than 98. Overall the results pretty much matched what I had anticipated. The chart below shows why:
Basically, since starting fasting in late November, I've gone from 213 lbs to a low of 167 after my most recent day of fasting, a total of 46 lbs. The decline began with an initial loss of 10 lbs during the first week and eventually settled at a pretty steady 2 lbs a week until I cut the fasting to 2 days a week. Fasting 2 days a week seems to keep me at a stable steady state, though if you squint, I may be losing a pound or two per month. It did not happen right away, but my blood pressure has also improved a great deal, from an average of 125/85 to around 105/70, all while reducing my BP meds from 2 to 1.
An interesting question is whether I could have accomplished the same thing simply by cutting my intake by the same amount, but on a daily basis. The medical literature on that seems a bit unclear. There are claims that fasting works better because it helps you maintain your metabolism, but I don't think the evidence on that is very strong. What is true is that for me, fasting was much easier to stick with than traditional dieting. Part of that is the fact that I don't find it difficult to skip meals. I love to eat, but I've often skipped breakfast and lunch in the past without difficulty. (In grad school I had concocted a plan to save money/time on food/meal prep by going to a $3 Chinese lunch buffet in Central Square in Cambridge for my one meal every day! Didn't actually go through with it however.) Psychologically I also find it easier to just not eat anything at all rather than trying control how much I eat. Mechanically it is also much simpler to just skip meals as opposed to keeping track of my calorie intake.
Having now been in this steady state period for 2 months, I feel as if I am finally in control of my health. Though I don't look forward to fasting, I am pretty certain I can sustain this indefinitely. I will probably stick to this schedule for a few more months before trying a longer water fast, say for 7 days. There is some anecdotal evidence (and animal studies, e.g., mice) that suggest that fasting can help autophagy kick in, allowing your body to breakdown and recycle damaged cells. One tantalizing hypothesis is that this may have cancer prevention properties.
One final note on exercise. I've never been particularly fond of physical exercise, but I've tried to be a bit more active. My standard routine these days consists of a morning and early evening walk with the dog for a total of 2 to 3 miles. About 4 days a week I also do a short routine consisting of 3 sets of 15 reps on an ab roller mixed with 3 sets of 15 push ups. That seems to keep my upper body and stomach reasonably toned. No 6 pack but not bad for a 53 year old. I might start jogging again some time. I had stopped about 10 years ago when my knees started to hurt. I suspect that with the weight loss, this should be less of an issue.
For the first time since I began getting tested on a regular basis, all of my glucose and liver function numbers are in the normal range. At peak, before I started taking metformin, my A1C was 7.7. Eventually I was taking 2000mg of metformin per day. It helped but my A1C was still around 7.0 or so. My old doctor proceeded to prescribe glimepiride, though I was very reluctant to take it, and only did so with very large meals. After I started fasting, I stopped glimepiride all together and gradually ratcheted down my dosage of metformin. On fasting days I skip it, but tried to take 1000 mg with most meals. On average I am probably taking about 1000 mg per day, since I did not always remember to take it with a meal. An interesting question which I am not ready to try yet is whether my numbers will go up much if I stopped all together. Because there is some evidence that metformin may have positive effects on longevity, above and beyond its ability to control blood sugar, I may continue with roughly this dosage indefinitely. Unlike glimepiride, it does not have the negative side effect of worsening insulin resistance.
My test results were not a surprise, though I had hoped that my fasting glucose would be better than 98. Overall the results pretty much matched what I had anticipated. The chart below shows why:
Basically, since starting fasting in late November, I've gone from 213 lbs to a low of 167 after my most recent day of fasting, a total of 46 lbs. The decline began with an initial loss of 10 lbs during the first week and eventually settled at a pretty steady 2 lbs a week until I cut the fasting to 2 days a week. Fasting 2 days a week seems to keep me at a stable steady state, though if you squint, I may be losing a pound or two per month. It did not happen right away, but my blood pressure has also improved a great deal, from an average of 125/85 to around 105/70, all while reducing my BP meds from 2 to 1.
An interesting question is whether I could have accomplished the same thing simply by cutting my intake by the same amount, but on a daily basis. The medical literature on that seems a bit unclear. There are claims that fasting works better because it helps you maintain your metabolism, but I don't think the evidence on that is very strong. What is true is that for me, fasting was much easier to stick with than traditional dieting. Part of that is the fact that I don't find it difficult to skip meals. I love to eat, but I've often skipped breakfast and lunch in the past without difficulty. (In grad school I had concocted a plan to save money/time on food/meal prep by going to a $3 Chinese lunch buffet in Central Square in Cambridge for my one meal every day! Didn't actually go through with it however.) Psychologically I also find it easier to just not eat anything at all rather than trying control how much I eat. Mechanically it is also much simpler to just skip meals as opposed to keeping track of my calorie intake.
Having now been in this steady state period for 2 months, I feel as if I am finally in control of my health. Though I don't look forward to fasting, I am pretty certain I can sustain this indefinitely. I will probably stick to this schedule for a few more months before trying a longer water fast, say for 7 days. There is some anecdotal evidence (and animal studies, e.g., mice) that suggest that fasting can help autophagy kick in, allowing your body to breakdown and recycle damaged cells. One tantalizing hypothesis is that this may have cancer prevention properties.
One final note on exercise. I've never been particularly fond of physical exercise, but I've tried to be a bit more active. My standard routine these days consists of a morning and early evening walk with the dog for a total of 2 to 3 miles. About 4 days a week I also do a short routine consisting of 3 sets of 15 reps on an ab roller mixed with 3 sets of 15 push ups. That seems to keep my upper body and stomach reasonably toned. No 6 pack but not bad for a 53 year old. I might start jogging again some time. I had stopped about 10 years ago when my knees started to hurt. I suspect that with the weight loss, this should be less of an issue.
