The burden of diabetes?

Burden is such a negative word, however the daily burden of diabetes care is not the part of diabetes that I want to talk about.  The burden of diabetes I'd like to discuss is the burden of proof required to make a consensus decision that nutritional therapy is the most powerful intervention available.

Diabetes is expensive.  I'd like to rant on that topic for a moment since I believe that the cost of the disease, both personal and systemic, are related to the larger burden on the evidence of proof required for organizations such as the ADA to prioritize the most powerful intervention (a low carb diet) as the standard of care for diabetics.  That is a burden.

Diabetes is physical burden, but the fact that following a low carb or even a ketogenic diet as I have to manage my diabetes is at odds with the established (and failing) convention adds to my mental burden.

[To reinforce this point on the burden of diabetes, my OmniPod insulin pump just went to the flat-line tone indicating that I need to do an equipment change at this very moment....  break to change Pod].  

...And I'm back.  Diabetes can definitely interrupt your life, but it can also suck you dry.  Even with the best insurance I could afford, I just paid $250 for 3 months worth of test strips and another $100 for 50 days worth of insulin.  That's on top of the $400 for a 3 month supply of the actual insulin pump's pods need that I stick to my body but am required to replace every 80 hours.  Then there is the adhesive enhancers, tape, alcohol wipes, lancet needles (which every diabetic should replace more often), batteries. 

I don't want to get too distracted by my rant of the personal financial challenge, but I'm as frugal as I can be with my diabetic expenses.  Why my insurance doesn't cover more is a topic for another morning, but when you value your health to the same degree as I do, it's easy to justify expenses in your own well being.  It's unfortunate that those "medical expenses" take away from the part of my budget dedicated to the intervention that has the greatest positive influence on my health (food), and will reduce my risk of supposedly inevitable diabetic complications.  Those complications would then spiral off into new realms of expenses.  How much is an open-heart surgery these days?  $40,000?  A hospitalization for diabetic ketoacidosis, which is a condition where a diabetic can go into a coma as a result of high blood sugar that can happen while following an ADA style diet).  I'm sure that stay wouldn't be cheap.  In a perfect would, my insurance would be paying 80% of my grocery bill enabling me to source the highest quality food.  I know I can eat a lot, and at times I could have expensive taste - but it would be nowhere near the cost to my insurance company of covering the cost of the pharmaceuticals involved with diabetes.  This argument is even stronger in the case of type 2 diabetics, which are an rapidly growing group suffering from a disease that can be reversed in most cases with early detection and nutritional intervention.  (rant over...for now)

So here I am, a very motivated diabetic... I've figured out how to manage my blood sugar numbers with a precise standard of "tight control" with a nutritional intervention.  But because the ADA was on the wrong path regarding their understanding of low-carb intervention, they have been slow to make the announcement that a low carbohydrate diet is an acceptable (excellent in my opinion) for of intervention for weight loss for up to 2 years.  

Why 2 years?  Because that's how long the 2 year study proves the intervention works.  You can assume if the study goes 3 years then the ADA would be able to recommend 3.  Sounds reasonable when you are adhering to evidence based standards.  That's actually ironic. There was very little evidence supporting the ADA recommended low-fat way of eating.  Now there is a burdon of proof to prove that a nutritional intervention works.  I have my own anecdotal evidence.  I've been diabetic for almost 2 years and I have been able to achieve an A1C of 5.1% which places my blood sugar control below the diabetic range.

My 5.1% is average for an average non-diabetic person.  But among type 1 diabetics, my achievement of a 5.1 is a 3 sigma event, which means it's 3 standard deviations from the norm.  To brush off your statistics knowledge, 1 standard deviation puts you in the 67th percental.  2 sigma is 97 percent.  3 sigma?  99.9th percentile.  That's right, I've won the lottery!  What is my prize?... health. I am happy and grateful for my health.  Health is a prize and it is worth pursuing.  The same health the average American takes for granted, but that's not you, right?

I've achieved diabetic control better than 999 out of a 1000 diabetics?  In two years?  In college I was only a B+ student.  In soccer I made it to All-conference, but never All-State, or All-American.  In triathlon I was happy to finish in the top 10% of the field.  I dedicated decades of my life to those pursuits, why am I so exceptional with diabetes after only 2 years?  There are incredibly diligent diabetics out there with years of experience who assuredly care about their health as much as I do.  But it's rare to see an A1C under 6%, an in all actuality, most doctors would reprimand a type 1 diabetic for pursing an A1C less than 6 because of the underlying assumption (based on the blood sugar variability typical of a high carb ADA diet), that tight control leads to severe hypoglycemic episodes....  an issue that I am yet to experience.  I've never been surprised by a low.  Never had a low I couldn't treat myself.  So why am I so good?  It's not ability.  It's not talent.  It's simple.  It's food.  A very low carbohydrate approach should be the first approach.  It was for me.

It is my own decision to not wait for the burden of proof.  Large organizations like the American Diabetes Association and the American Heart Association are like big ships that take too long to turn around.  Diabetes and Heart Disease are icebergs near on the horizon.  The ship started turning last year.  If that ship is like most medical knowledge it will take another 15 years before those ships end up on a better path.   

I'm enjoying this analogy. Consider me man-overboard. I have chosen my own path. Luckily, I am a strong swimmer.

For more information from respected MD's and PhD researchers who are blazing this path well ahead of the curve, please check out the most current research from Feinman et al., in journal Nutrition.  This article discusses the unfair burden faced before conventional medicine will fully support and endor

Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base

BIG NEWS.

My first announcement is in regard to this past year. Only some of you may know that I have become a Nutrition Counseler following my recent diagnosis with type I daibetes.  Managing my Type I Diabetes is my first job, and now teaching others how to avoid continuing onto the path of Type 2 is my new job.  I deal with patients with other health issues as well, but it's shocking the high and ever increasing fraction of people who are heading that way! And the damned thing is, that this epidemic is due to previous nutritional advice to avoid saturated fat, eat whole grains, and consuming sugar is harmless.  ALL THREE OF THOSE STATEMENTS ARE FALSE!  We have all become sicker as a result.  I am so happy to be able to sit down and work with people on how to reverse this.  Prior to my diagnosis, I never would have guessed how wrong the conventional wisdom regarding nutrition actually was!  Seriously, this health issue affects nearly everybody.  I'd hate to see my friends miss out on the benefits that I have learned.  You are my friends (and family).  I care about your health.  Consider this my Public Service Announcement - for my friends.

So with that important announcement out there, onto my second BIGGER announcement.  (Again, some of you may already know).  But next year I will be participating in my 5th Ironman triathlon - and my second since diagnosis with Type I Diabetes.  On September 13, 2015 I will race Ironman Wisconsin and FUNDRAISING for a nonprofit called RIDING ON INSULIN. I will have 38 other teammates with type 1 diabetes along with a few others who are closely connection to the diabetes world (parents, family, friends - members we consider "Type Threes"). To learn more about it go to www.ridingoninsulin.org/ironman. Funds raised will help kids with type 1 diabetes go to camp.

My FUNDRAISING GOAL is $1500 as soon as possible!  I'm not dragging this fundraising thing out to keep pestering people, $1500 between the number of caring friends I have out there should be achievable. I'm asking my closest friends to donate $100 (minimum), especially you Epic folk.  As for those of you who I only see periodically I'm hoping you'll help to chip away at the total, How's $20 bucks sound? That's enough so that next time I see you in person you don't have to uncomfortably avoid eye contact.  And if this message is shared with you through a mutual friend...?  $10... $5?  Thank you!


Donate to my effort here!  https://www.stayclassy.org/fundraise?fcid=334383

My PERSONAL GOAL is to demonstrate the advantages of the nutritional advice which I counsel.  I'm putting my money where my mouth is.  In my first Ironman as a diabetic I finished comfortably in the 13 hour range and fast walked most of the run.  My goal for this second effort isn't necessarily to go faster, although there is time to be gained from my walk with Bernice... My goal in 2014 is to repeat my successful blood sugar management.  If you read my race report from IMAZ 2013, you'd know I managed to maintain my blood sugar between 70 and 130.  Those numbers may not mean much to my non-diabetic friends, but it's damn impressive!  My goal here isn't to brag, but most diabetics would be happy to have that level of control on a day where they do nothing. Managing such tight control isn't due to that fact that I'm super smart or gifted, or even necessarily all that athletic.  It's simply due to the foods that I use to fuel myself.  It's actually quite simple.  Coincidentally it tastes delicious.  It's admittedly different than from what I thought "normal" food was, but knowing what I know now, even if I wasn't diabetic, I'd choose to continue to eat this way.

My goal is to share with a much larger diabetic audience, what I have learned that allows me such amazing stability.  I'll share it wiith anyone who asks.  I have a stable HbA1C of 5.1%, and my other metabolic markers have improved from already good, to better.  Of course I'll share this. If this can work for me it can work for anyone.  I won't pressure anyone - I know no one like's that guy!  I hope to simple demonstrate what I have learned.  Everyone should have the option to try this if they'd like - currently it's not even mentioned during treatment! It's not for everyone, but for those interested in athletic endeavors, I'd argue this way of eating provides performance advantages.  I do it for health reasons since it's enabled me to manage spectacular control though every event I have done since. For example, while I wasn't incredibly happy with my time at the Big Swell 2.4 mile swim this summer, I entered the water with a blood sugar of 82, and finish the race 1 hour and 14 minutes later with a 90.  That was fun!

So to summarize... Fork it over.  It's an excellent cause.  I'm not looking to make money here - it's for KIDS for crying out loud!!!  I was diagnosed as an adult, but I wouldn't have wanted to be the only diabetic kid at camp, nor would I have wanted to miss out!  I know some of you may not like kids... j/k.  Seriously, it's for kids, fork it over!  $100 close friends, $20 to be spared an awkward next meeting.   :)

Again, donate here:  https://www.stayclassy.org/fundraise?fcid=334383

Thumbs up - Crisis is Opportunity.

I wrote this post on my Kindle because I can only Swype - but not type right now. I'm a bit new to the device but it's my best option for the simple reason that my right thumb is bandaged up and throbbing. Earlier today while chatting with my girlfriend I promised to start getting my blog back going again and I wanted to hold up that promise - and I hope to return to my blog more frequently.... girlfriend? Yes.

There has been a lot of change in my life this year. My closest friends know much of the story, but I'm only left to assume most of my friends, of which I am blessed to have many, have been left on there own to figure out where I've disappeared to this year.

To put it mildly, this year featured some major challenges for me.  Many of those challenges are things which I never would have chosen to experience if I had a choice in the matter.  But perhaps the greatest lesson which I have learned is that control of one's own path is an illusion.  I've rolled with the punches very well, took a few licks (and while I'm by no means able to claim that all of those experiences are well in my past....) I have emerged, already at this point as a stronger person as a result of those tough experiences.  I remember learning (although this fact my not actual be true) that the Chinese symbol for crisis is the same as the symbol for opportunity.  Perhaps that's not exactly true and a good reason for me to avoid tattoo parlors, but I believe the concept is sound.

Since my last post a lot has changed. Honestly even back in February a lot had already changed which I wasn't entirely comfortable publicly admitting, a lot of changes were already in motion.  Prime example, I got divorced, which was entirely not something I ever wished for or wanted. Perhaps it's for the best but I am not one to quit, especially not on someone I had promised to love the rest off my life, alas the lesson is that I was not in control of that fate. I tried to delay  the process and wait for cooler heads to prevail, but even that effort back fired and further upset my now ex wife to the point that the only conversation I've had with her in the past 6 months was in a court house.

As if that wasn't shock enough I lost my job at about the same time.  That situation turned ugly as well and led to the loss of someone which i had considered to be one of my closest friends.  Meanwhile, the only thing I could control (diabetes) was going just fine. I felt selfish putting my health first in the situation, but had I not been selfish with my health, I would have been unable to be at the point at which I now find myself.

The combined losses (as well as the subsequent financial damages) led to the opportunity for me to move in with my parents into a mutually beneficial situation.  Through serendipitous good fortune I quickly stumbled into a new career path where I now am able to counsel much needed nutritional advice under the guidance of a brilliant Integrative Health M.D..  Living at home has enabled me to reconnect with both of my parents on a new level.  While I have experienced loss, that loss has helped me learn to appreciate the important things that remain in my life.

I spend the early mornings drinking coffee and sharing bacon and eggs with my father.  His symptoms from advancing Parkinson's disease are much milder in the mornings. And while he may struggle with the fork, getting out of a chair, or visual aberrations. He's been is sound and his memory remains (for the most part). I'll take what I can get.  His fine accepting of my nutritional guidance and has experienced some dramatic improvement when he adheres closely to the plan. He's even had days where he's been back on his bike, rising circles around the neighborhood. Not every day is a good day, but well both take what we can get. As he learns Rio understand what we been working toward, my hope is that his well-being will continue to improve.

My late mornings are spent in the car, a wonderfully reliable VW Passat. Each direction of my commute is 100 minutes, but I've learned to use that time wisely. I download academic lectures to my iPod, and have explored several new books thanks to Audible, and surveyed a variety of entertaining podcasts available on Stitcher. My commute is through the scenic back roadsand feature farmland, windmills, lakes, the occasional horse pulled buggy, and rolling hills. I arrive to work at 9 am wide awake and relaxed, ready to take on the world.

Taking on the world describes my work very well.  I lucked into a job with a doctor with whom I see very much eye with regarding our nutritional approach to health. For over 30 years he has been marching to his own tune practicing medicine with a standard of care rarely seen. Initial consults last 90 minutes, during which I am part of the conversation. I am learning a level of detail well beyond what I would in a conventional medical practice.  Following their meetings with Doc, clients meet with me for several in depth discussions on how to best modify their dietary intake to enable them to heal and/or optimize their health to their greatest potential.  I am free to counsel and on all aspect health. My primary focus is nutrition, but the best part of  the Integrative/ Functional health approach is the view of the body as a system. Already I am seeing massive improvement in their health whether it's qualified in pounds lost, improvements in bio markers, or simply improvements in mindset and energy with which they can approach each day.

While conventional medicine focuses on the narrow specialties and sub specialties, the functional approach looks at the bigger picture resulting from the interactions of the each of these specialities. It's easy to argue that conventional medicine is far superior with urgent care and trauma, but the functional approach excels with complex cases where symptoms affect multiple organ systems. Functional medicine also excels with its ability to proactively address preventative health.  I get to spend multiple hours establishing a relationship with each unique members and coaching them towards new behaviors that can have very powerful long term influences improving the long term quality of life as well as their ability to continue to perform both physically and mentally.

Each day I met exceptional individuals and am openly humbled by their personal stories of struggle and their intinct to fighting for their health above and beyond a point where the establishment has given up on them. Issues range from chronic fatigue, Adrenal fatigue and/or failure, Lyme, auto immune disease and all to often, cardio vascular disease and metabolic syndrome.  Every day I'm learning. As a smaller clinicc we are adaptable and able to explore new fields of opportunity to best serve the health needs of our clients. I was educated in the conventional method as a scientist and biochemistry researcher, only to now witness the advantages of a more individually tailored and personal approach to health and medicine.

Every night I settle in front of  a stack of reading which  can range from the latest findings from PubMed, or the numerous books published by other functional medicine practitioners eagerly share they wisdom, or even a variety of cookbooks through which I search for nutrient dense yet approachable meals that may best suit each of my unique clients needs.  I have been enjoying the process immensely.

I have found very little time for unimportant activities such as tv and movies, or the tv news.  I have learned to utilize Facebook s a powerful social networking tool which allows me to connect with other Type 1 diabetics interest ed in obtaining the same level is tight blood sugar control for either themselves or their T1D children.  I catch what I can of the news through NPR podcasts on my ride home, but try not to stress my mind with problems over which I have little to no control. I leave it to my mother to keep me abreast of any of the worlds problems, the score of the brewer game and the weather report as I prepare our evening meal together. She has been coming around to change her food habits since experiencing significant improvement in her blood sugar control and losing nearly 20lbs through eating as much (of the right food) as she cares to eat, including copious amounts of butter. She still enjoys a slice of gluten free udi bread periodically but has come to her own realization that she has better energy, less digestive issues, greatly reduced joint pain from her rheumatoid arthritis and the elimination of her for neuropathy by eating gluten free, greatly reducing the processed food and significantly reducing her carbohydrate intake.  20 years she's been a type 2 diabetic and I'm the first person to discuss the effects of carbohydrates with her.  I try not to let that fact upset me, but we all are a little extra protective of our mothers..especially a mothers but such as myself living with my parents at the tender age of 35. I'd like to see her doing even better than she currently is, but shed likely say the same about me.

I've enjoyed my return home. These will be my last few days living with my parents full time. I've signed a lease in the Warner Park area of Madison which cuts my daily commute roughly in half, although I'll still be spending nearly 2 hours a day in the passat. I'll be living with a close personal friend who is fully on board with the type of healthy life I aim to live. We each bring our unique experiences to our budding roommate relationship. Neither of use enjoy living alone. We are both social creatures. He's a friend who was there for me through my crises/opportunities. We are both excited about our future impacts on health. As a bonus, he is also trained as a nurse and capable of providing excellent care should I experience any unforeseen diabetes related issues.  Plus he'll teach me organic gardening and martial arts skills in exchange for lessons on bicycle repair and carpentry.

Living in Madison also provides another great opportunity.  I can work on building a stronger relationship with my new girlfriend, Megan.  She is very understanding of my emotional experiences of the post. She is supportive, compassionate, gentle, yet strong and has the most genuine smile. I'm not one to blindly rush into a relationship. My past wounds admittedly still sting. She had been incredibly understanding of those circumstances. As you can figure out from the nature and breadth of this post, I'm one to wear my emotions on my sleeve, I accept the dangers of being hurt again, of which uses feel the risks are relatively low.  But I'm not going to hide from the risk of failure and miss an opportunity to enjoy a relationship with someone who has to this point only made me a better person all while accepting me for who I am despite my flaws.  I'm not perfect. I make mistakes too....

Speaking of, I probably have numerous typos and humorous and/or confusing auto corrects in this ever rambling blog.  Earlier this evening I lopped off a good sized piece of skin from my thumb while excitedly slicing my gigantic Kolrabi which I just harvested from my garden.  Just in time to have to move a bunch of boxes and build a lift for my bed in the new apartment. Perhaps this is an opportunity to lean to be more ambidextrous.



post-script:  I'm including a link to my latest adventure and likely the topic of many of my upcoming posts.  I am raising funds for the organization "Riding On Insulin".  I signed up to join nearly 50 other Type 1 diabetics competing together at Ironman Wisconsin 2015.  My goal is to raise $1500 by the end of September.

Donate Here.

Gluten cross-reactivity testing.

Here's my vent for the day.  Even with all the right things that I do, things still get messed up sometimes.  I know I have food sensitivities - a few that I haven't yet figured out.  I'd like to know for sure if I need to give up coffee, same for dairy.  My life would be much cheerier with both :).   Whose wouldn't?!

I work in a Integrative health center and was going to get a food antibody test done (gluten cross reactivity assay...Cyrex Assays 2 & 4).  I know I have issues with gluten already (not celiac, but definitely not tolerant).  I read that if I don't eat gluten for the test it would likely report a false negative.  So I ate gluten yesterday, but then was too busy at work to get the blood lab done.  And I felt fine yesterday, but today I feel rather crappy and my insulin requirements have doubled and I'm getting bloated, achy and stuffy nose.

Sucks that I have to actually do something bad to myself to test these things out.  Maybe it's best that I have more time between my gluten exposure and the test.  Maybe that will allow more time for my body to produce the antibodies that the test is looking for.  Looking for the silver lining.

I'm still managing to keep my BGs around 120mg/dL, but that's rather high for me.  I feel much better at 80 - but again, that's just me.

Endurance training meets Integrative Health

Less is more for elite athletes and cancer patients

The above link should take you to a 5 minute video on cancer and improved recovery with targeted aerobic exercise.  The 'zone' they discuss is optimum to train in is based on blood lactate accumulation vs clearance rates as measured in the blood while exercising at progressively increasing rates of work.

Warning.  There is a full minute worth of commercials before the video.

Lactate testing and aerobic metabolic testing are the aspects of endurance training that I enjoyed studying the most as a coach.  I haven't been able to get my hands on that type of equipment.  We used an alternative protocol to successfully estimate those same zones without the blood testing.  I think being able to do the full testing like in the video would be very interesting.

An athlete could use the Respiratory Quotient (RQ) to calculate what fuels were being used at particular rates of work.  Makes for great targeted training, but more importantly, from the ratio of CO2 v O2 exhaled you can tell whether fat or carbs are being burned.  It's an insight into the metabolic state of the mitochondria.

I had a test like this done on me in Vancouver before my diabetes diagnosis.  It showed that despite my massive cycling endurance, I was a heavy carb burner, even at low efforts - over time (like several hours) I'd bet I had be getting into fat burning, but I only did metabolic tests lasting for 15 minutes or so.  The maximum exertion tests are not very fun.  Suffocating.  Reaching maximum effort on a automated ramped protocol where the resistance increases by 30 watts every minute while cycling.  While breathing through a tube.  

So why do I want to have this tested again?  I bet I would see a massive downward shift in my respiratory quotient. Ketones burn even cleaner than fats so I'd predict that my RQ would be significantly lower for each level of increasing work.

For training and racing I can use this info to figure out what fuels were being burned during an event so that I know what fuels (protein, fat, carbs..) to replace to optimize performance.  The ratios of the fuels depends on the level of exertion for the intensity of each event.  Athletes train for events of a variety of distances, therefore each event will have a different fueling plan.  I'd also be curious to figure out basal metabolic rates by monitoring respiration at complete rest.  With that information there would be a more complete picture as to the total daily energy expenditure.  

That number could be used to figure out the amount of fuel (calories) that needs to be replaced.  While I'm not a believer in the classical calorie in, calorie out philosophy I believe that the amount of energy obtained form each fuel source, whether it's from protein, carbohydrate or fat is variable depending on the state of the metabolism.  Variable to a particular individual at a particular state of health.

Beyond athletic performance, what these numbers really are a look into is the metabolic health and efficiency of the mitochondria.  Mitochondria are everything for health!  I cannot emphasize that enough.  They are our energy producing furnaces, treating them poorly can be a factor in nearly every chronic modern disease, especially those affecting the brain.  

The shit of it all is that when something is affecting your brain, rarely are you able to notice it until it is too late.  Having a measure of your mitochondrial efficiency is likely an insight into your overall health and vigor (endurance).