Biology Diabetes Health

Diet or Diabetes

To be or not to be

Sweetness has always been associated with good things. And sugar has been an obsession for many. But sugar has a good many effects that are not good. And some are affected in worse ways than others. We need a certain amount of glucose in our systems to live. That amount has been described as about a teaspoon in all of our blood at any given time. The rest has to be consumed, excreted or stored. Most of us who love sweet things rarely consider what the impact of consuming large quantities could be.


There is a national epidemic of overweight & obesity, metabolic syndrome and diabetes that was become worse over the past 30 years. While there have been many articles written and documentaries made the situation has become worse and worse. Nutritionally dense processed food tastes good and recently we have begun to realize that salt, sugar, and carbohydrates are behaviorally addictive. My belt size and weight had gone up over the past several years and my workouts did not seem to be having any impact. After several months of my youngest daughter insisting I have a physical (and stop putting so much sugar in my coffee) and signing a contract with her I listened. 

Lose It 

On July 17 I had a physical examination and was told to lose 30-35 pounds and essentially get to a weight that I had not been at since I was running 50 miles a week. I was told to give up  pasta and bread and to skip potatoes. Thinking about all the delicious fresh, home-made bread my wife makes, along with lasagna, pesto, all sorts of pasta, and my love of pizza I said “No way. My wife is Italian. I don’t think that is going to happen.” I considered the near impossibility of losing just 5 pounds. Maybe with a tremendous effort it would be possible to drop 15. 

Motivation: Blood Sugar Sky High

But one day later, I was told I had a random blood sugar of 180 and an A1c of 8.5 (which indicated an average blood sugar of around 220) .  My doctor suggested a low carb diet, but was doubtful I’d follow through after my response the day before. He also suggested perhaps I visit an endocrinologist and take Metformin. I said “no thank you” to the idea of Metformin and said I thought we could handle this ourselves. 

I had an immediate change of heart and felt this was a great time to be motivated for a dramatic change in diet. What did I think I needed most?

  • Need to not be diabetic.
  • Need not to be on unnecessary medication.
  • Need to work on problems caused by being overweight:
    • High A1c and Blood Sugar
    • Overweight
    • Clothes fit
    • High Blood Pressure
    • Need to face up to the impact of diet health.
  • Need to realize that one can not live by workouts and the gym alone. 
  • Need more energy. Lately energy had been slacking from my unknown high blood sugar

Thinking about the domestic and global epidemic of overweight and obesity, I had to face the fact that I was joining this group and needed to change.

Changes: Trim the carbs. Keep the fat

I knew there were two possible ways to handle a dietary change. One was a vegan or vegetarian diet and the other was a low carb diet which is nutritionally ketogenic also called “Keto”. I was well aware that Tim Noakes had embraced this diet and received opprobrium in return. You can google his story which he describes quite well in both book and on YouTube. But as a long time follower of his I knew he had advocated a LC/HF (low carb – high fat) diet for years. He called it the “Banting Diet” after  William Banting who wrote  “Letter on Corpulence, Addressed to the Publicadvocating this low carb diet for weight loss back in the 1800’s. Claude Bernard, a French physiologist, known for the concept of “homeostasis” had previously described a diet for diabetes which eliminated bread, butter, milk, sugar, beer and potatoes.

To me this approach made sense, although I know of people who have lost significant weight with a vegetarian approach. Eliminating most carbohydrates which would lead to higher glucose and a very variable blood glucose seemed logical. A quick literature search easily brought up dozens and dozens of academic articles. Further looking led to podcasts, online lectures, and books on the science, beginning Keto and Keto Cookbooks to read. And to my surprise, this diet had become popular and to some was known as a fad diet. I have not spent time following diet fads and trends so I had no idea.


I had at least two people tell me the “Keto” diet would kill me. Both were vegan and hopefully were not eating pesticide sprayed fruit. 

The word seemed to be that this diet is a hard road to follow and difficult to sustain.

I was given the task of 1200 kcal per day and decreased carbs. The lowest recommended calories is higher than this, so don’t try this on your own. 

One friend passed on a good number of presentations on the plant based diet, most of which were quite good. But I was well convinced that my path laid with the “Banting”, low carb approach. I also learned of the very hostile politics that is inherent to much of human interaction, and it was also present here in diverging nutritional opinions which should be based solely on science.

Tossing Out The Bread With the Chocolate Milk and Caramel Macchiatos 

Lots had to go. The first thing that came to mind was a lifetime of daily chocolate milk and for as long as I can remember sugar, milk and a touch of cocoa in my coffee.And a good number of cups of coffee each day. In fact, my coffee consumption was enough to power enough calories for  another meal each day. While much of my diet was considered healthy and included chicken, salmon, other healthy fish and vegetables, I did consume sugar chocolate milk, and would have an occasional “chip” binge. Warm, fresh, home made bread with butter was a periodic delight. But now, I can have the butter but not the bread. And over the past few years, ice cream became a joy.

So out went sugar, pasta, high fructose corn syrup, most fruits (except for certain berries), ice cream, fruit juices, chips, chocolate cake, breaded anything, most glutens, wheat flour, a good number of vegetable oils that were not olive oil. 

In came whole eggs, unprocessed bacon, more salmon, fish, chicken, occasional london broil, turkey burgers, blackberries, raspberries, blueberries, 5% Greek Yogurt, a very small daily piece of dark chocolate (85%), 1/2 piece of gluten-free crisp bread with a tablespoon of humus, almond butter, almonds, macadamia nuts and pecans. Much of my vegetables are green leafy kale, spinach but also broccoli, cauliflower, avocados and zuchini. 


This was done immediately, whole heartedly, and very seriously. Absolutely ZERO cheating. I obsessively read all food labels. I started going food shopping. I helped (at least a bit, like a back-seat driver, but tried to help) with food preparation. And I began weighing just about all of my portions.  

And most important I have kept track of my meals in a smartphone app. There are several apps available. I am using myFitnessPal to track food groups and calories. And I used a website to determine a good set of “macros” for protein, fat, and carbohydrate which was easily incorporated into myFitnessPal. 

I had great help from my wife in choosing low carb but tasty food. Some of the early options included chicken rolled in curry, pesto chicken, salmon, and tilapia with a variety of toppings. The vegetables I ate were all at her suggestion. 

Short Term Results

Before my weight went had gone down 3 pounds, my blood sugar dropped to the normal range. At the start my random blood sugar was 180. A week later my fasting blood sugar was 95. And it has not been higher than this since then. My weight has steadily decreased. I was able to stop taking 2 of 3 blood pressure medicines. And I needed to use smaller belts to keep my pants up. My energy level improved. And there was not much in the way of hunger pangs. The diet has been filling without spiking sugar or adversely impacting insulin. 

Longer Term Results

About three weeks in I went out for sushi with my doctor. He noticed the early but significant weight loss and was impressed with my daily blood sugars. I told him of my new found fear of carbs and how the rice in the sushi now scared me. It turned out that the restaurant would roll the sushi wrapped in cucumber without rice. But the surprise was my doctor was following the same diet and we then both happily ate sashimi. 

In less than 3 months my weight went down about 28 pounds and my waist size decreased about 5 inches. My blood sugars both fasting and after eating have all been at normal levels, well below 100, usually in the 70’s and 80’s. And a home test kit for A1c showed my A1c to be down to 4.8. I will have an in office test before the end of October and I expect the then 90 day test to be no higher than that and likely a bit lower. 


At a nephew’s wedding about 6 months ago, I spoke with one of my wife’s cousins. He was definitely enthusiastic about his diet which helped him lose over 100 pounds over a year or two. He didn’t just say that his low carb diet was good. He said it was great and discussed the physiology of it in more detail than most people would even think about. A few months later we met again just after I began the same nutritionally ketogenic HC/LF diet. This time I had a lot of questions to ask. He told me about the importance of electrolyte supplements, fluid replacement and foods that were helpful and those that were not.  And he encouraged me to get a Ketone meter. I did, and use it every now and then. But the results are what has let me know things are working.

About 6 weeks or so into this process I contacted a friend, Mark Cucuzzella MD ( who is a Family Physician in West Virginia, and on the faculty of the West Virginia University School of Medicine. Dr. Mark is one of the most community oriented people you could hope to meet. He owns a running shoe store, is involved in the racing community organizing and sponsoring races, and he even has a dozen bikes that are lent out to people in the community at no charge. Mark is an active lecturer nationally and around the world on diet, exercise, shoes and biomechanics and health. He has served for years as an Air Force Reserve Lieutenant Colonel. All this and he has maintained a running schedule that has had him completing 30 consecutive yearly marathons under 3 hours. His best time was 2:24. Dr. Mark’s involvement with his community, patients and students is inspirational. 

I remembered from our first meeting a few years ago that Dr. Mark was an expert in nutrition in addition to being involved in the mechanics of running and training. So after finding a good number of interviews, a book and podcasts, I thought I’d drop him a note about what I had been doing. He was very supportive. We also discussed the possibility of using a CGM (continuous glucose monitor) to see what foods might be causing glucose spikes. Dr. Mark immediately sent me a presentation he had done online for physicians and a dozen or so articles on the importance of maintaining a level glucose and the impact of a low carb diet. We had the chance to spend a lot of time together at the annual American Academy of Podiatric Sports Medicine seminar in Cambridge, Massachusetts. His lectures were the best since many of them involved going outside and moving on those beautiful September days.  I’ve learned much from Mark and continue to do so. 

All through these past few months I’ve read journal articles, blogs, listened to dozens of podcasts and online lectures. I’ve read books on getting started on ‘Keto’, books on how the science works and how to handle athletes attempting a low carb diet (it varies), and  books on low carb cooking. There are many resources available. I’d recommend researching the low carb diet thoroughly if you have reason to believe it would be helpful. Your public library is likely to have a good number of books on the shelves, surrounded by a lot of other diet books. But when I visited my library I wasn’t distracted. I knew what I was looking for.  

The Impact of Nutritional Ketosis Over 11 Weeks

Total Weight Loss: 28 pounds 

A1c from 8.5 down to 4.8

Fasting Blood Sugars: In 70’s and 80’s

Blood Pressure: Significantly lower on less medicine

Waist from about 39-40” to 34”

Energy level: significantly improved

So now, my blood sugar is normal. My clothes fit. My blood pressure is improved. And I don’t need to take any medicine to keep my sugar in the normal range. This worked faster and better than I would have believed. 

In an upcoming post, I’ll list some of the authors, researchers and references I found helpful. 

Biology Diabetes Health Microbiome

Diabetes Type 2 (T2D), Metformin and The Microbiome

Microbiome analysis is coming soon to a doctor near you. Microgenomics is going to be part of nearly everyone’s future. This week Nature magazine published an article which indicates that at least part of the action of the anti-diabetic medication Metformin may be occurring via the microbiome. At the leastMicrobiome Metformin there is a dramatic difference between the gut microbiota between those with type 2 diabetes (T2D) treated with Metformin (T2D-Metformin+)and those not treated  (T2D-Metformin-).

The article has an excellent discussion both of the direct effects of Metformin and the indirect effects and potential interactions of various gut bacteria







Forslund, K., et al. (2015). “Disentangling type 2 diabetes and metformin treatment signatures in the human gut microbiota.” Nature advance online publication. Accessed Dec. 2, 2015