11. Conclusions

11.1   A summary of the changes I made

Based on the information available from Professor Taylor's studies on reversing Type 2 Diabetes I set my weight loss target as 18kg (which was the 15kg typical weight loss mentioned in his trials plus a margin), and I told people my target (which caused hilarity in some quarters!).

·         I followed Michael Mosley’s 5:2 Fast Diet, fasting twice a week for 24 hours then eating a single meal of 600 kcals for dinner.  I did this throughout my six months of weight loss phase.  Because the cell autophagy turned on by fasting has benefits well beyond simple weight loss, I am continuing with 2 days of fasting each week in the post-weight loss or maintenance phase but have relaxed the calorie intake to 800 kcals since my focus is no longer on weight loss and 800 kcals provides a very substantial evening meal.  (In fact Mosley has recently increased the daily limit on Fast days to 800 kcals but recommends a minimum fasting period of 13 hours.  If you only have one meal in the evening on Fast days then you actually have a 24 hour fasting period).

·         For the five “Feast” days each week I adopted the dietary principles of the Mediterranean diet outlined in “The 8-week Blood Sugar Diet” (BSD) and ate, on average, about 2000 kcals each Feast day.  The Mediterranean pattern of eating is a low carb approach that avoids free sugar, simple carbohydrates, and foods that have been significantly processed.  It avoids any foodstuffs that are labeled “low fat” and encourages consumption of whole milk and fermented whole milk products like kefir, yogurt, and yogurt cheese, as well as fermented vegetables like kimchi and sauerkraut.  The consumption of good oils (monounsaturated and polyunsaturated) is encouraged through consumption of nuts, seeds, avocados, and good quality cold pressed extra virgin olive oil.  Dark chocolate above 85% cocoa content and small amounts of red wine are also on the menu.

·         I stopped grazing.  On Fast days I had one meal a day and on Feast days generally I had breakfast, a light mid afternoon snack, then dinner in the evening.  Definitely no in-between nibbles!  Interestingly too, my desire to graze just disappeared, as the diet progressed, probably because the elimination of free sugar and starchy carbohydrates minimized the highs and lows of my blood sugar.

·         I got back in to the gym for regular sessions of cardio and weight training as well as High Intensity Training, expending an average of 2500 kcals per week throughout the weight loss phase.

 I continued to drink red wine and malt whisky although my average consumption remained at 2 units per day, and there was definitely no consumption on Fast days.

11.2  … and these were my outcomes   

 I lost 19.6kg (43lbs) of fat which reduced my body fat composition from 29.5% to 8.3%.  I also gained 2.1kg (4.2 lbs) of lean muscle so that my net weight loss was 17.5kg (38.5 lbs).

·         My blood sugar level, as measured by the HbA1c test, dropped from 42mmol/mol, the pre-diabetes threshold,  to 36mmol/mol which is absolutely normal.

·         My total cholesterol level dropped from 6.6mmol/mol to 5.7mmol/mol. More significant however was the change in the ratio of “good” to “bad” cholesterol.   My HDL levels rose so that the ratio of Total Cholesterol to HDL dropped from 4.5 (showing an increased risk of heart disease and related health issues) to 2.7 which is firmly into the normal low risk area.

     My average weekly blood pressure dropped from 122.0/79.5 to 119.5/72.6.

M

·         The occasional ectopic heart beats that I have experienced since my schooldays have declined significantly.  Not quite gone, but almost.

·         My ear wax has disappeared.  Go figure!

·         I experienced an enormous increase in energy, even on the Fast days, from the first week of the diet.  On average I sleep about 1.5 hours less than previously yet wake up feeling full of energy and completely rested.

·         My breathing and airways improved significantly and I’m told I’ve stopped snoring!

·         Although it is impossible to measure accurately outside of a lab, my aerobic capacity, as measured by the VO2Max, has increased hugely.  That is also reflected in my resting heart rate dropping from 54bpm to 45pm, which is close to the 41bpm that I had when I fenced regularly in my schooldays.

·         I discovered during a short term return to eating free sugar and simple carbohydrates over the Christmas 2018 holiday period that they are not just bad for blood sugar control and insulin resistance but actually make me very tired and lethargic, with symptoms not unlike the Chronic Fatigue Syndrome I was diagnosed with a few years ago.  As a result I have completely removed free sugar and simple carbohydrates such as bread, potato, and pasta from my food intake.  I still eat complex carbohydrates in the form of whole grains, pulses, and legumes which provide about 35% of my daily calories.

·         The shift to the Mediterranean style of eating substantially increased the amount of fruit and vegetables I consume – from 5 portions a day to 14.2 portions a day.  These are split roughly two thirds vegetables to one third fruit.    I  avoid the sugar rich tropical fruits like pineapple and mango in favour of berries (strawberries, raspberries, blackberries, cherries, blackcurrants, and blueberries) and whole fruits such as apples, pears, oranges, and plums.  I typically eat about 250-300g of frozen berries every day.

·         The increase in vegetable consumption has had a very beneficial affect on my fibre intake which has increased almost threefold from 15g per day (under half the recommended amount) to 40g per day.

·         My dairy consumption has increased  because of the kefir and yogurt I now eat, as well as my continued consumption of traditional (i.e. non-processed) cheeses.  I have eliminated daily café lattés from my diet and have cut back to occasional flat whites to try to limit my total consumption of dairy (even although I am not really sure why limiting dairy is recommended!).  Nevertheless I am still getting about 20% of my daily calories from dairy products which is well above the recommended 8%  specified in the Eatwell Guide, for which I cannot find any substantive justification.  My consumption from dairy is actually very similar to that of the average French person (who still has only one third of the risk of heart disease compared to the UK).   Given that I think the Eatwell Guide is poorly written, confusing, and out of date, I am not going to lose to much sleep over ignoring its recommendations for both carbohydrate and dairy intake.

·         My protein consumption has remained almost twice the limit specified in the Eatwell Guide, in spite of reducing my intake of meat and fish protein.  That’s because there are surprising levels of protein in vegetables even if vegetable protein is usually considered “incomplete” compared to meat and fish due to the lack of some key nutrients.  I remain completely confused about whether my protein consumption is actually too high because the available information and guidance is downright contradictory. Blood tests show my kidneys are OK so my current protein consumption does not seem to be a problem.

·         My consumption of total fat and saturated has actually increased substantially since I changed from my former low fat diet to the Mediterranean diet.   I no longer fear fat or saturated fat!  However my increased fat consumption is the result of eating more good oils from unprocessed sources such as walnuts, almonds, avocados, and olive oil rather than direct consumption of refined fats.   My average fat intake per day  is only just above the recommended limits set in the Eatwell Guide.   In any case the spectacular improvement in my blood lipids seems to completely contradict the formerly universal view that eating fat made you fat and clogged up your arteries.   My results suggest that eating a bit more fat while eliminating starchy carbohydrates has resulted in a huge reduction in my bad cholesterol.   However, a word of caution before you reach for the frying pan and lard!  I have made several significant changes to my diet and lifestyle so just focusing on my increased fat consumption would be  wrong.  The only thing I can say for certain is that the whole regime of changes which include fasting and the Mediterranean food pattern, along with vigorous cardio, resistance, and HIT exercise, have resulted in those fairly spectacular improvements to my blood sugar and cholesterol levels. I do not think you can easily cherry pick the best bits!

There are a couple of downsides to this exercise.   As my layer of insulating fat has almost gone I feel the cold for the first time in years, and my varicose veins now seem much more prominent!   Seems a small price to pay really.

11.3  ...and finally …

I hope you have found this blog useful. I am neither a doctor nor a nutritionist so this blog is only a record of what I did in under six months to reverse the threat of medication for high blood sugar and cholesterol.  During this time I found myself learning that my former “low fat” diet may not actually have been as healthy as I thought  (although I ate it for forty years!) and that sugar and refined carbohydrates actually bring on feelings of tiredness and extreme lethargy in me.

I think Professor Taylor's concept of the Personal fat Threhold provides a plausible answer to the question I originally posed about what had caused my blood sugar to go from normal to pre-diabetic even although there had been no major change in lifestyle or diet.

I became enthusiastic about a more vegetarian style of food and was amazed to discover the stunning food that arises when you treat vegetables as the main course, not as a side dish, so much so that I am now entirely vegetarian on four nights of the week and, on the other days where I include meat and fish, the animal proteins are really the sides, not the main event.  For someone who has always been passionate about food that is a hugely significant change, for it means that the dietary change has not been a burden but actually a very welcome improvement.

If you have been diagnosed with high cholesterol and blood sugar and struggling to find clear dietary advice then I hope my blog at least gives you some encouragement that it is possible to reverse high blood sugar and cholesterol without drugs.  At the very least you may find answers to the mountain of questions I had at the start of this exercise.

This diet and lifestyle change certainly worked for me but fat storage and release is a complicated process which is significantly affected by our individual make up, genetics, and gut health.   We are all individuals and do not respond like machines.  However, in spite of that statement, I find it very encouraging that my blood test results after the six months  matched almost exactly the improvements reported by Dr Michael  Mosley for himself.   Maybe we are all not so different after all!

The takeaway has to be that high blood sugar and cholesterol does not necessarily require a lifetime of drugs and may well be fixable by relatively simple lifestyle changes, but of course you should speak to your doctor first before making any significant changes to diet or lifestyle.    If you have any questions about this blog and what I did to take control, or if you discover additional information you would like to share,  then please email me at email@ianennoch.com.

Lastly I would like to thank the doctors at my local surgery in Aultbea for delivering the kick in the pants I needed to implement this change, I would like to thank Richard and the team at the Gairloch Leisure Centre for helping me rediscover my mojo in the gym, and final thanks are due to Nurse Joan for persuading me to write this blog in the first place.

Ian MacLennan

“Malbik Endar”

June 2018