T2 or NAFLD? ...or, a funny thing happened on the way to the surgery

[Chris24Main]

I take a vitamin D3 (with K2 for better absorption) - 4000iu as a daily supplement - a years' worth should only be the cost of a couple of Lattes.

I can't explain why this isn't better known, but vitamin D deficiency is quite common, particularly in winter when we may not be getting much access to sunlight. There is some evidence, which I link to below, that associates vitamin D deficiency directly with impaired beta cell function, so my personal opinion (and what I've done) is to take this cheap supplement because it ensures that vitamin D deficiency cannot be an issue.

Relationship Between Vitamin D Levels and β Cell Function and Insulin Resistance - PMC

Background This study aimed to determine the relationship between vitamin D levels and β cell function and insulin resistance in patients with diabetes, glucose tolerance disorder, or impaired fasting glucose. Methodology A total of 75 outpatients ...

pmc.ncbi.nlm.nih.gov

There are some legitimate concerns with effects of very high dosage vitamin D prescription, particularly in combination with Calcium, so I should stress that I'm not taking any meds, and any intent to change anything should be discussed with your support team first.

 

[Chris24Main]

Let's skip past vitamin B and C - though I may double back to them later...


Article in PubMed - about vitamin D

The Role of Vitamin D and Its Molecular Bases in Insulin Resistance, Diabetes, Metabolic Syndrome, and Cardiovascular Disease: State of the Art

In the last decade, an increasing awareness was directed to the role of Vitamin D in non-skeletal and preventive roles for chronic diseases. Vitamin D is an essential hormone in regulating calcium/phosphorous balance and in the pathogenesis of inflammation, insulin resistance, and obesity. The...

www.mdpi.com

[The Role of Vitamin D and Its Molecular Bases in Insulin Resistance, Diabetes, Metabolic Syndrome, and Cardiovascular Disease: State of the Art](https://www.mdpi.com/1422-0067/24/20/15485)

Difficult to neatly parse out what the important stuff is here, or how to explain it. Reading the entire article was like watching a firework display in my head - vitamin D is really quite amazing stuff, and nearly criminal that none of this is common knowledge. I should maybe contextualise that by saying that vitamin D cannot be patented, it's highly available, and cheap - a year's supply of daily max dose is £10 - so there is no business case for splashy advertising, and no company can claim anything unique about a vitamin D based product; so it's just not made a big deal out of - but the more I dig in, the more I think that for all new diabetics - daily vitamin D supplements should be more or less the very first thing that is talked about in terms of treatment.

Let me back up - how would I have described Vitamin D? Well, I think I would have mentioned Rickets - so vitamin D is linked with bone health, so if you don't have bandy legs, you probably have enough vitamin D. That's how I saw things.

However, if - particularly when I was initially trying to figure out what insulin resistance meant - anyone had told me that vitamin D and insulin resistance are directly linked - and that you can accurately describe vitamin D as a hormone that regulates insulin resistance - that would have caught my attention.

I'll take another starting point. Early on in my journey, a couple of people whose perspectives I was coming to trust mentioned that "if there was one supplement I would take, it would be vitamin D; make sure to get that with D3 an K2 so that you can absorb it, and take the max dose". So, I did, and I've been taking 4000u tablets every day for maybe 6 months. Never thought much more about it, but it's been on the list of things to take a deep dive on. More recently, my daughter was taking the micky about my vitamin D obsession and I figured I needed to actually get into it, so I dug, and that state-of-the-art study just blew my mind.

Recently, we've been talking about plant and animal variants, and so it is with Vitamin D. The difference in this case, is that both need to be converted into the active form of vitamin D, which is better thought of as a hormone, as there are receptors for this active form on many cell tissues, including the β cells of the pancreas - and it turns out that vitamin D plays a crucial role in this tissue.

Then - I would encourage anyone interested to read the article, but at the same time, be warned that it's pretty heavy going; I don't think I would have followed half of it even a few months ago. As it is, I can follow enough to get the gist, but would struggle to explain some of the finer points. I'll have a go at laying out what I see as being important - and as far as any form of diabetes is concerned, there is no more important vitamin.

Vitamin D is a hormone that sits under, and enables, the action of insulin. It's like a foundation for insulin to work. It actively regulates the transcription of insulin receptors. What does that mean - well if you are deficient in vitamin D, this will limit cells (all over the body) from interacting with insulin properly - what does that look like? insulin resistance.

This is so important, it's worth just repeating more plainly - a lack of vitamin D will directly increase insulin resistance. Most people don't have enough.

The next thing to consider falls under the general question of how to best look after your pancreas, and the β cells that produce insulin. So, this is to do with calcium - and that's probably what vitamin D is best known for, and indeed if you hugely overdose on vitamin D, the effects are all related to calcium excess, but for the pancreas, its more about energy - and to make sense of that, we're all familiar with talking about types of battery as if they were metals, right? Like Lithium ion battery, or Nikel-Cadmium (Ni-Cad) - so the "batteries" in the β cells "run" on calcium (or the regulated charge of calcium ions) - and its vitamin D that regulates this - so the actual function of β cells is directly impacted by vitamin D deficiency.

Vitamin D affects how well β cells function

There is more to the effect than this, vitamin D directly affects and regulates the way that the immune system interacts with the β cells - both directly and indirectly. I'll spare you the gory (highly technical) details, but to my understanding, there is a huge connection to "how can I extend the honeymoon period" as well as "can my β cell function recover", even to "I'm not T1 now, can I do anything to help lower the risk?".

Vitamin D improves the ability of β cells to recover, or not get dysregulated in the first place.

That's quite a contentious thing to say - so please understand that I'm offering it as an interpretation of what the "state of the art" is relating to the various functions of vitamin D - I'm not saying that any one person should do anything nor am I predicting any effect.

One point of note is that, even in this analysis; it's clear that there are few studies looking at the practical implications, and in most cases, where there are, the results are disappointing and often conflicting. Everything I'm laying out is based on our (quite real) improvement in understanding of mechanism. Taking that to a study result that can show benefit is costly and difficult; and I would refer back to the start of this - there isn't any motivation for any company to put money into "proving" the effectiveness of vitamin D because there cannot be any return on that investment.

The last thing I want to draw a line to, because CVD (heart disease) is the biggest statistical risk for all diabetics, is that vitamin D also plays a direct role in the flexibility of your arteries - the "stiffening" that we talk about; vitamin D plays directly counter to that (again, I follow the science, and it's related to Nitric Oxide). More broadly, as a hormone, it plays many important roles in the regulation of all lipids.

Vitamin D keeps your arteries flexible

Vitamin D is also directly able to combat oxidative stress, inflammation and high blood pressure - it's really a master regulator of the immune system throughout the body.

So - to close, I started off with the idea that taking vitamin D was a low-cost low-risk no-brainer, and bought a year's supply (with K2 for better absorption). The more I read up, the more I agree with that initial thought.

There is a connection with exposure to sunlight that I should at least touch on. (we synthesise vitamin D from sunlight, oh, and that vilified substance, what's it called; oh yeah, cholesterol). I've heard it said that not getting enough sunlight is more dangerous than smoking. That also goes against what we have been told about worry about skin cancer; but as I read deeper into the article and understand just how much of a difference vitamin D makes to all aspects of health, and every facet of diabetes, and the risks of developing diabetes, I'm more and more inclined to agree.

@Antje77 - if you see this - this is the background for all of my thinking about vitamin D. I understand the wariness about discussing thing at this kind of depth "in front" of someone facing a new diagnosis, but I totally stand by the conclusion that anyone interested in supporting the function of their beta cells should be getting sufficient sunshine, and/ or taking vitamin D3 with K2 for better absorption, up to the maximum safe dose. There are no downsides I've been able to find, but I welcome your thoughts on this...

 

[djp23]

Hi, after posting an introduction, I was encouraged to start a thread - my story will be specific and probably not applicable to most on this forum, because I'm becoming increasingly convinced that my diagnosis is not correct. a reply from @JoKalsbeek has only helped cement in my mind that the advice and treatment I have received have not only made me feel worse, and set me back significantly, but would also make my only good course of action more difficult.

That said, I'm not blaming my GP, or consultant, and the upside is that it's given me a rare insight to help myself. Please allow me to elaborate. You may want a (low carb) beverage for this...

Just before Covid entered our lives, I realised that I needed to get my BMI below 27 because of the risk of Diabetes (I use the sloppy term deliberately because that is all I knew at the time). I wasn't hugely overweight, but I had an undeniable beer belly, and I drank too much. I didn't smoke, and I typically cooked form fresh; I like veg, and really dislike soda.. so I thought it was all ok. Totally unrelated, but my younger, healthier and better looking brother died suddenly and tragically, and that forced a bit of reassessment and soul-searching.

I then started a two year controlled (calorie controlled mind) diet, using MyFitnessPal to log meals and a wireless scale to track weight, and a hybrid smartwatch to log steps and exercise, and a gym-quality elliptical trainer to do more cardio - really lucky ebay purchase. I started drinking less, and the less I drank, the less I wanted to drink.

After a couple of years, and ... really hard work... I was close to hitting my goals... but pretty soon the weight started to go on again... and so I upgraded my scales to show body composition, and my MyFitnesPal subscription to show the breakdown of all meals I was having, and to increase the discipline. More exercise, and I started paddleboarding regularly, and use a Slendertone belt daily.

After another year or so, I was at my target weight, and it was sticking - I had, if not a six pack, then something along the lines of a two pack, if I held in my stomach and squinted a bit.

Understand, I'm not bragging - and I dropped maybe two and a half stone, it wasn't miraculous or anything, just that this is the level of effort you need to go to for a 'do more, eat less' approach to actually work - and I went through the dizziness and constant hunger and coped - essentially at 52 I was a poster child for recommended diet. I was close to fully tea-total by this point, and hadn't smoked anything for more than two decades.

In April of last year, I took part in a 'Future Health' study and had a series of blood tests, and one of the benefits to me was that they would get in touch if there was any concern about Diabetes.. they didn't

In June, two months later, I had a regular checkup as a 50 plus with my (excellent) surgery, and went in with an ironically high level of smugness.. for once in my life, I don't need to lie about any of the things I'm being asked..

A couple of weeks later, I get a call on the way to go Paddleboarding, and I'm told to pull over so that I can take the news that my blood glucose levels are alarmingly high. Days after that I'm on the conveyor belt through Gliclazide, then insulin (when it was assumed I could only be Type 1) and then more recently Metformin (once we were all convinced that it was definitely not Type 1)

But a hanging question has never really been resolved - how could I be healthy in April and dangerously unwell in June ?
And how could I have done everything modern guidance asks of all of us (to an obsessive degree) for three punishing years - and still be diagnosed Diabetic ?

First things first - I presented with weight loss, lots of urinating and lots of drinking water. Hilariously, I had convinced myself that I was properly hydrating, and that it was deliberate, but then our SodaStream yearly subscription was complete in four months - I couldn't argue that I wasn't drinking too much water... I did talk about the weight loss being controlled, but tick-tick-tick - let's get you on the Type-1 treatment. It's by far the most dangerous situation, and despite no family history, it was feasible... so, it seemed like the right call.

After a few weeks of that - we still hadn't had the blood test results looking for anti-body evidence of autoimmune function that would show type-1 or 2 - and so we moved to insulin and a glucose monitor. I suppose most on this sub-forum won't have a great deal of experience of that, but there is a lot to take in, and the support system kicked in. I felt really well looked after, and with some effort, my levels got better - but still spiked surprisingly, and nobody could tell my why. 'Sometimes this just happens' was an answer I got a lot... but I was telling people, 'The only time I feel unwell is when the levels are changing rapidly, it seems to me like the absolute numbers are less important to the amount of change...'.

I should mention - not that I'm looking for sympathy of course - that 5 months of insulin totally wiped out all the effort I had put in for three years - my weight went back up to where it started in a more or less straight line. I didn't complain - the more serious thing was that my blood glucose was being controlled... yes, I understand the problem with high blood glucose, I'll do whatever you ask.

Then I had an appointment with a new consultant, she began the 'interview' by asking about Ketone levels at my first presentation... and as I began answering, said 'wait, I don't trust people', and phoned my surgery to get the answer. When she put down the phone, I showed her my iPad, where I keep notes of everything, and displayed the same answer from a scan of the letter from the surgery. How were we going to have a dialog when she wasn't trusting my answers? 'Oh, I didn't mean that I didn't trust you, just that I don't trust anyone...' Suffice to say that the appointment was a little tetchy from that point. I'm sure she's sat in front of many people she knew to be lying to her face, but it's not the best strategy to build trust and confidence.

Anyway - she was pretty sure I was not type-1, to her credit, and asked me to take another test to finally put it to bed, that test looked for a triggered response of naturally produced insulin, which was positive - clearly, I could only be type-2.

So, that was fine, but I got the news in a letter asking me to drop the insulin and switch immediately to Metformin with 'supplements per NICE guidelines'. I felt that I couldn't just upend 6 months of learning to control the Most Important Thing - my blood glucose level, and needed to understand the whole thing better, so waited till I could speak to my GP. She was great, explained everything, and what Metformin was and what it did.

Which was great, except that some of what she said turned out later to be wrong, particularly in terms of Metformin's primary function.

So - I was now a new type-2, my levels were still too high, and spiking a lot, particularly in the morning. What the hell had kicked this all off ?

When I thought that I was just an unlucky person with late onset type-1, I was prepared to do anything; the hardest thing was accepting that this was now my life, and I'd worked hardest on that. Now, I had to turn my whole thinking on all of this around and start fresh. I needed to learn as much as I could - I didn't really know what glucose was or what made you insulin resistant. I just felt that things didn't add up for me, and I needed to figure it out myself, because where I was headed was really bad.

Luck took me to a YouTube interview with Dr Jason Fung, and then I immediately got his book 'The Diabetes Code' - and I went to bed literally shaking after devouring half of it.

The simple truth was that having reached my weight goals, and keeping my weight steady, I decided to treat myself with Honey. After all, it was natural sugar, we can't burn it, so it's a free pass, and I could see that it was having no effect on my weight. Soon enough, I was having Honey on my cereal in the morning, on sandwiches at lunch, sometimes a little to spice up the family meal that I would cook, and as a snack on Ryvita before bed. I was also mainlining grapes - we would buy four packs a week, and I would eat most of them. Grapes are fantastic in a calorie-controlled diet, because of their calorific density - lots of water... so again, a free pass.

I'm astounded at my own ignorance. Just gob-smackingly incredible.

I understand the mechanism better now, but in simple terms, I had overloaded my liver over and over to the point that my pancreas couldn't keep up, and had gone into beta-cell dysfunction, leading to a rapid rise in blood glucose... in weeks.

Having had that picked up, 6 months of additional insulin was the absolute worst thing I could have done... and now I'm taking the one drug that primarily blocks my liver from unburdening itself.

Unchecked - I'm on a path of taking more and more metformin to address the symptom of high blood glucose, until that stops working, then more insulin..

None of which would ever actually address the problem, that I simply have too much glucose, fructose and insulin in my body in the short term.

The one great positive of my situation is that I continue to wear a continuous glucose monitor (essential to avoid really bad things if you are type-1, but it turns out, very useful indeed for, well, everyone) and I was able to test the various theories in 'The Diabetes Code' and then Jessie Inchauspé with 'The Glucose Revolution' - everything totally stacks up with the evidence I can see with my own eyes, and the things I had intuited from the start.. the glucose spikes were the problem, and I had done this to myself; but I could undo it too.

Turns out, it takes eight weeks of force feeding Geese on Corn Syrup to make Foie Gras - that's what I had done to myself, and the system picked up on the resulting blood glucose level.

Anyway - quite enough rambling from me... where I am now is a full week into alternate day fasting, with close to zero sugar or starch on the eating days. I'm also not taking any metformin, because I can see on my monitor that my blood glucose is only marginally higher than a metabolically healthy person. I'm also supplementing with Huel daily greens, to make sure that the sudden change in diet does not result in loss of nutrients.

I only intend to do this for a month, and to present the results (massive, significant results in only a week) to my GP to force the issue - why, given this would you argue for Metformin? and I have an appointment with the Dietician about a month after that, at which point I may still be doing some form of intermittent fasting, but nothing so extreme, and with low, but not close-to-zero levels of starchy foods and following Jesse Inchuspé's recommendations to do so with no glucose spikes.

I still feel well looked after by the 'system' - I understand the decisions made and the treatment given, GPs only have 10 minutes at a time to make these decisions, and people are just unreliable at telling you the truth, or following a plan - so they treat with medication; can't blame the GP for doing their job.

But - I wish I'd known even a fraction of this much earlier in life..
If you've managed to get to the end of this Wall-o-text, thank you, I know my story is important to me, but otherwise it's just someone's story, and I appreciate you taking the time.
Best of luck (and better advice) on your own journey.
Chris

Just wow......I follow both Dr. Chung and Jesse. Both crazily accurate about diet etc., I love your writing by the way and now more determined than ever to protect not just myself but my hubby from T2D. Thankyou for taking the time to write this and I advise others to take heed!

 

[Chris24Main]

Many thanks @djp23 - I think I get more out of this thread than anyone - if nothing else it's a relief valve; but I can't tell you how much it helps on top to get feedback like that.

 

[Antje77]

@Antje77 - if you see this - this is the background for all of my thinking about vitamin D. I understand the wariness about discussing thing at this kind of depth "in front" of someone facing a new diagnosis, but I totally stand by the conclusion that anyone interested in supporting the function of their beta cells should be getting sufficient sunshine, and/ or taking vitamin D3 with K2 for better absorption, up to the maximum safe dose. There are no downsides I've been able to find, but I welcome your thoughts on this...

My dislike of this discussion on a thread by a newly diagnosed antibody positive diabetic stems from your post possibly giving the idea that vit D may save their beta cells. https://www.diabetes.co.uk/forum/threads/is-this-lada.208749/post-2755343
This is a thread by someone who'll likely face a T1 diagnosis in the near future, and who'll have to get used to insulin injections, carb counting, etc.

Let's skip past vitamin B and C - though I may double back to them later...


Article in PubMed - about vitamin D

The Role of Vitamin D and Its Molecular Bases in Insulin Resistance, Diabetes, Metabolic Syndrome, and Cardiovascular Disease: State of the Art

In the last decade, an increasing awareness was directed to the role of Vitamin D in non-skeletal and preventive roles for chronic diseases. Vitamin D is an essential hormone in regulating calcium/phosphorous balance and in the pathogenesis of inflammation, insulin resistance, and obesity. The...

www.mdpi.com

[The Role of Vitamin D and Its Molecular Bases in Insulin Resistance, Diabetes, Metabolic Syndrome, and Cardiovascular Disease: State of the Art](https://www.mdpi.com/1422-0067/24/20/15485)

Difficult to neatly parse out what the important stuff is here, or how to explain it. Reading the entire article was like watching a firework display in my head - vitamin D is really quite amazing stuff, and nearly criminal that none of this is common knowledge. I should maybe contextualise that by saying that vitamin D cannot be patented, it's highly available, and cheap - a year's supply of daily max dose is £10 - so there is no business case for splashy advertising, and no company can claim anything unique about a vitamin D based product; so it's just not made a big deal out of - but the more I dig in, the more I think that for all new diabetics - daily vitamin D supplements should be more or less the very first thing that is talked about in terms of treatment.

Let me back up - how would I have described Vitamin D? Well, I think I would have mentioned Rickets - so vitamin D is linked with bone health, so if you don't have bandy legs, you probably have enough vitamin D. That's how I saw things.

However, if - particularly when I was initially trying to figure out what insulin resistance meant - anyone had told me that vitamin D and insulin resistance are directly linked - and that you can accurately describe vitamin D as a hormone that regulates insulin resistance - that would have caught my attention.

I'll take another starting point. Early on in my journey, a couple of people whose perspectives I was coming to trust mentioned that "if there was one supplement I would take, it would be vitamin D; make sure to get that with D3 an K2 so that you can absorb it, and take the max dose". So, I did, and I've been taking 4000u tablets every day for maybe 6 months. Never thought much more about it, but it's been on the list of things to take a deep dive on. More recently, my daughter was taking the micky about my vitamin D obsession and I figured I needed to actually get into it, so I dug, and that state-of-the-art study just blew my mind.

Recently, we've been talking about plant and animal variants, and so it is with Vitamin D. The difference in this case, is that both need to be converted into the active form of vitamin D, which is better thought of as a hormone, as there are receptors for this active form on many cell tissues, including the β cells of the pancreas - and it turns out that vitamin D plays a crucial role in this tissue.

Then - I would encourage anyone interested to read the article, but at the same time, be warned that it's pretty heavy going; I don't think I would have followed half of it even a few months ago. As it is, I can follow enough to get the gist, but would struggle to explain some of the finer points. I'll have a go at laying out what I see as being important - and as far as any form of diabetes is concerned, there is no more important vitamin.

Vitamin D is a hormone that sits under, and enables, the action of insulin. It's like a foundation for insulin to work. It actively regulates the transcription of insulin receptors. What does that mean - well if you are deficient in vitamin D, this will limit cells (all over the body) from interacting with insulin properly - what does that look like? insulin resistance.

This is so important, it's worth just repeating more plainly - a lack of vitamin D will directly increase insulin resistance. Most people don't have enough.

The next thing to consider falls under the general question of how to best look after your pancreas, and the β cells that produce insulin. So, this is to do with calcium - and that's probably what vitamin D is best known for, and indeed if you hugely overdose on vitamin D, the effects are all related to calcium excess, but for the pancreas, its more about energy - and to make sense of that, we're all familiar with talking about types of battery as if they were metals, right? Like Lithium ion battery, or Nikel-Cadmium (Ni-Cad) - so the "batteries" in the β cells "run" on calcium (or the regulated charge of calcium ions) - and its vitamin D that regulates this - so the actual function of β cells is directly impacted by vitamin D deficiency.

Vitamin D affects how well β cells function

There is more to the effect than this, vitamin D directly affects and regulates the way that the immune system interacts with the β cells - both directly and indirectly. I'll spare you the gory (highly technical) details, but to my understanding, there is a huge connection to "how can I extend the honeymoon period" as well as "can my β cell function recover", even to "I'm not T1 now, can I do anything to help lower the risk?".

Vitamin D improves the ability of β cells to recover, or not get dysregulated in the first place.

That's quite a contentious thing to say - so please understand that I'm offering it as an interpretation of what the "state of the art" is relating to the various functions of vitamin D - I'm not saying that any one person should do anything nor am I predicting any effect.

One point of note is that, even in this analysis; it's clear that there are few studies looking at the practical implications, and in most cases, where there are, the results are disappointing and often conflicting. Everything I'm laying out is based on our (quite real) improvement in understanding of mechanism. Taking that to a study result that can show benefit is costly and difficult; and I would refer back to the start of this - there isn't any motivation for any company to put money into "proving" the effectiveness of vitamin D because there cannot be any return on that investment.

The last thing I want to draw a line to, because CVD (heart disease) is the biggest statistical risk for all diabetics, is that vitamin D also plays a direct role in the flexibility of your arteries - the "stiffening" that we talk about; vitamin D plays directly counter to that (again, I follow the science, and it's related to Nitric Oxide). More broadly, as a hormone, it plays many important roles in the regulation of all lipids.

Vitamin D keeps your arteries flexible

Vitamin D is also directly able to combat oxidative stress, inflammation and high blood pressure - it's really a master regulator of the immune system throughout the body.

So - to close, I started off with the idea that taking vitamin D was a low-cost low-risk no-brainer, and bought a year's supply (with K2 for better absorption). The more I read up, the more I agree with that initial thought.

There is a connection with exposure to sunlight that I should at least touch on. (we synthesise vitamin D from sunlight, oh, and that vilified substance, what's it called; oh yeah, cholesterol). I've heard it said that not getting enough sunlight is more dangerous than smoking. That also goes against what we have been told about worry about skin cancer; but as I read deeper into the article and understand just how much of a difference vitamin D makes to all aspects of health, and every facet of diabetes, and the risks of developing diabetes, I'm more and more inclined to agree.

This post you quoted speaks of vit D deficiency causing insulin resistance.
We have no reason to assume that this newly diagnosed member has a vit D deficiency or insulin resistance, and their thread was a question on their lab works and diagnosis. In my eyes your post made things even more complex than a new diagnosis already is, and on a subject possibly not even relevant. Why not ask if they've had their vit D levels tested instead and go from there?
Nothing in your link suggests it's beneficial to start supplementing if your levels are normal.

The source you used on that thread is on a study on rat cells (in vitro).
The source quotes in vivo studies which have shown reduced secretion of insulin from pancreatic islets in mice suffering from vitamin D deficiency. The insulin secretion was shown to improve by vitamin D supplementation.
Again, those mice did not have T1 diabetes and they did have a vit D deficiency.

What those researchers did was make it clear what they based their conclusions on, and nowhere did they conclude that all newly diagnosed diabetics should start taking large doses of vit D.
But you posted a link to a study to tell a newly diagnosed likely T1 exactly that, even though the researchers never said this.

Don't you think that the avalanche of new information upon diagnosis is enough without adding a mouse cell study on cells of mice who don't even have the same condition?

I totally stand by the conclusion that anyone interested in supporting the function of their beta cells should be getting sufficient sunshine, and/ or taking vitamin D3 with K2 for better absorption, up to the maximum safe dose. There are no downsides I've been able to find, but I welcome your thoughts on this...

Getting to terms with needing lifelong medication can have a very large impact. I wouldn't add to this a strong advice to take another lifelong tablet, especially not without first establishing if there is indeed a deficiency.
I know firsthand how demoralising it was when my bedtime routine suddenly involved swallowing a handful of tablets, and it would have made me very unhappy if someone on the internet with some authority (you're a mod) told me to take yet another tablet.

I happily take my vit D, lab tests made it very clear I need it, even though I'm outside all the time.

 

[Chris24Main]

Well, thanks for that @Antje77 - I did ask and you've certainly answered.
I will say that the link I had posted was quite possibly inappropriate, for the reasons you list. I understand your perspective and the need to be sensitive. All the work I put into researching the effects of Vitamin D that went on this thread - informed this thread only, but the one link that I pulled out in response to being asked to provide a link has fallen short. That is on me.

Thank you for taking the time to express yourself here, and not in the original thread. I've said over and over that I welcome correction. I have no claim to be right about anything, this is all a genuine attempt to learn. I don't have any sense of being an authority, I'm only following the evidence as I can find it, and being open about what I find.

What I would say though, is that I was in precisely the position you describe, facing a lifetime of medication, and I was struggling to figure out the central question of whether my pancreas was inevitably failing or whether it could recover. All 43 pages of this thread are something of a reflection of that central question, and what role insulin resistance plays.

I do know exactly how overwhelming and demoralising that can be, or at least I know how I felt.

If anyone had been able to tell me that - whatever else, your beta cells cannot function properly if you are deficient in vitamin D, and that it's surprisingly common, and more than that - a safe and cheap supplement can ensure that you are not deficient...

I have to disagree with you - I would have jumped at that knowledge. Knowing that, I still stand by my recommendation, and in fact I feel strongly that it's unjustifiable not to offer that knowledge.

Your central point seems to be (and I don't want to put words in your mouth, so please understand this is only my interpretation) - that someone who is likely to be LADA should not be having more weight put on their shoulders, particularly if there is no existing deficiency. I get that, and again, maybe my response fell short.
I just see it the other way around - and of course, maybe that's just because my pancreas has recovered - but I feel to my bones, that we should encourage the pancreas, and support it - and that all the advice I got personally by the medical team was just to write off the pancreas and wait for it to die. I don't think that's right, and if something as simple as ensuring you are not deficient in vitamin D could help - and it's so cheap (not to mention so beneficial more broadly, as I laid out in some detail earlier in this post) - then it's a piece of information that anyone confused about LADA or not, should be offered.

[and to be 100% clear, I do agree that this is better offered as a piece of information than a recommendation; I will take that on board]

 

[Chris24Main]

So, I'm going through something of a personal challenge to my "figure everything out from the ground up" approach.
I have my yearly review coming up, and in preparation for that, I had a set of bloods - all the usual, and with the exception, naturally, of the LDL-C count - all is good.

Except that I immediately got a call from the surgery asking if I could arrange a repeat, as my eosinophils were high.

That was news, so I delved back into the results, and sure enough, on the full blood count, eosinophil levels are well above the normal range. 2.54 (billion parts per litre) where the normal range is 0.04 to 0.5.

So - what the hell are eosinophils and why might they be high?

Eosinophils are a type of white blood cell, made in the bone marrow in response to certain cytokines (inflammatory particles - kind of "alarm messengers"). They travel around the blood system, and then flood areas of inflammation, specialising in dealing with parasites, fungal attacks, but can also be involved in the fight against a viral attack, or certain cancers, particularly cancer of the blood (leukaemia).

Having levels five times higher than the normal high threshold is therefore not something to take lightly.

But - I don't have any symptoms of anything (well, that day I did feel a little low on energy, like maybe I was fighting something, but it was all gone).

Fast forward 10 days, and I have the results of the repeat test. Eosinophil levels are still well above the upper threshold at 1.2.

But - I still don't have any symptoms - of anything. One of the big likely results of a high eosinophil level with a patient with asthma, is a kind of allergic severe asthmatic attack - but I'm using my inhaler much less than I ever have, and my breathing is completely clear.

Outwardly, my level of inflammation has literally never been so good. So, what gives?

So, I did my usual thing of reading the hell out of the situation, is ketosis associated with high eosinophils - no, the reverse. Is higher vitamin D associated with high eosinophils? I have been talking about not being deficient, maybe that's coming back to bite me? - no; vitamin D *deficiency* is associated with higher eosinophil levels - it's really a fundamental pointer at some other cause of inflammation, yet everything I think I know should be telling me that my inflammation is low.

Then I came across this article:

Eosinophil biology from the standpoint of metabolism: implications for metabolic disorders and asthma - PMC

Eosinophils, recognized for their immune and remodeling functions and participation in allergic inflammation, have recently garnered attention due to their impact on host metabolism, especially in the regulation of adipose tissue. Eosinophils are ...

pmc.ncbi.nlm.nih.gov

Now, it's complicated (natch) - but really interesting.

To do my usual thing of condensing the entire article into something that makes sense; research is showing that in fat-adaptation, these cells become increasingly different in their basic behaviour.

or - "The phenotype of the resulting eosinophils will be anti-inflammatory in the context of adipose homeostasis as they would preferentially produce cytokines to support an anti-inflammatory adipose tissue microenvironment and lipolysis" - if you prefer a direct quote.

Instead of thinking about these cells as being there purely to fight off parasites, you need to think about what inflammation is, in the chronic sense, including all of the direct connection between insulin resistance and inflammation. These particles also play a part in the, what is referred to in this article as "energy storage metaflammation" - regulating the inflammation in adipose tissue caused by those cells (particularly in the liver) having to swell up to store more and more fatty acids (which are the result of dietary sugar and starch).

But - if there is less of that to do, these cells (and also, being cells with mitochondria, they are also now burning fat for fuel, and working better because they have more cellular energy) switch to a role which is more about energy and thermal regulation in these adipose cells - you may remember me talking about brown fat cells and them being used to generate heat rather than energy, - well, this role is about "beiging" fat cells - making them more "brown" and therefore able to burn off more energy..

.... which makes sense in someone who is typically burning about ~7gm of fat per hour (reading that directly from this morning's ketone measurement) - I need more ability to regulate that, so these specialised cells are switching from what they do in the "normal" sense, so something far more beneficial.

However - I now have an appointment to discuss this with (another) doctor on Monday. That is going to be an interesting discussion, because this is now totally outside the scope of diabetes. I may be totally wrong, and I have a parasite infection, or cancer. But, I think this is just another case of the rules changing as my metabolism improves.

 

[Melgar]

@Chris24Main Back in 2022 I had high Eosinophils. I cannot remember how high they went but they were high. It was the same time my coeliac ramped up along with the immune skin condition I got that later turned out to be Dermatitis Herpetiformis. I stopped eating anything with gluten and these Eosinophils normalized. There are a number of conditions from parasites to autoimmune. Cushings too. I'm sure you have researched all the possibilities. I hope your appointment with your Dr on Monday goes well for you.

 

[Chris24Main]

Thanks for the support - and I can totally see the way that this played out for you @Melgar - that's the way I think it must be in the vast majority of cases - this is a bad thing to have elevated.

Cushings, is of course something I'm personally interested in, since it killed my mother, but that all revolves around Cortisol, and my blood pressure this morning was 105/70 - and very low blood glucose, so my cortisol is not elevated.

I've done a bunch more digging into this, and truly believe that this is one of the scenarios where the rules are simply different when you become more metabolically efficient and flexible - there is a particularly apropos quote in that article I linked -

"This shows that there is direct effect of reducing insulin resistance, with the change in phenotype of eosinophils."

Adiponectin is a big player, and another indicator that fat storage cells (adipose tissue, where the "adipo.." in adiponectin comes from - these are far more involved and endocrinologically complex than we have thought. (or I have tended to think, anyway)

essentially, eosinophils are seen as a sign of evil things going on, and so they are in most cases, but when you transfer to burning fat and reduce all the inflammation that comes from all the glucose (and I understand that even accepting that this is the case is a stretch for most) - then these cells completely change what it is they are doing, and go from a ...

Well - it's kind of like a troop of soldiers, the war is over; and they stop rampaging, and start helping to build schools - but they are the same soldiers..
Anyway, we'll see on Monday if I can persuade anyone to go with that...
I still feel fine, I can't be having an onset of Coeliac - I haven't had anything with gluten in it for a year, I've had my share of skin conditions, but all that is better than it ever has been...
But - we'll see..

 

[Melgar]

I feel confident you haven't got coeliac. As you know without the gluten in your diet the immune response will not be triggered, so there would be no civil war going in your body. It is easy for me to say, but try not to stress over it. I was totally ignorant when I saw my Eosinophils out of range. I didnt know what they were, but this was in 2022 . I'm a bit more wiser now. Other than my blood sugar which sat in the diabetic range, and by cholesterol , everything else was fine. There are many things it could be. Cancer always pops up no matter what disease or malady you look up. Also, and this is way off base , as you love the lakes, and you recently took a spill in the water, water born parasites are ever present in lake water. We have Giardiasis or commonly known as 'beaver fever', in our lakes here. A nasty world wide parasite, but you would likely be in some gastric distress with that. I'm guessing they will do a bunch of tests to get to the bottom of it. One never really thinks of these things until you get that bold out if range alert!

Fingers crossed for you @Chris24Main .

 

[Chris24Main]

Again, I really do appreciate the support, but it's like you're ignoring the central thrust of what I'm saying...

I don't think elevated eosinophil levels ... in my body right now... are a marker of a civil war going on. They may very well be in most people, but most people are in some form of metabolic dysfunction and inflammation, which forces them to be this way.

For me, I am more and more convinced (I mean, these were first measured two weeks ago, and I've felt just brilliant the entire time) that per this research, in a better metabolic environment - like when you become fat adapted, and get out of the way of your immune system - these cells can get on with other, more beneficial tasks, like making adipose tissue more brown.

I measured my ketones this morning, and the way they are described, is that I am burning 7gm of fat per hour. I mentioned this to my wife, and she said "that seems like a lot.." and it is.. if you've never experienced this kind of metabolism.

.. but ... that energy !! I feel like I'm fizzing over with enthusiasm, and positivity.. pretty much all the time.. (I mean, to the point that it just sounds silly writing it..) .. and my body effectively has to come up with additional ways to waste more of the spare energy.. thats what brown fat does, it literally wastes more energy as heat.

What the article describes, is a change in behaviour of eosinophils ... in the condition of switching metabolism to fat burning ... to being more engaged with this temperature regulation, than with the immune response defence that they are usually associated with.

Why do I need to be looking for reasons to expect that I've inadvertently swallowed parasites in river water, or that there is cancer (which is also much less likely in a low-inflammation state) ... why not be positive, when the science suggests that this is a positive situation?

 

[Tazdevl]

Just read the majority of this post. Interesting and I wish I could tap into your energy

 

[Chris24Main]

Many thanks @Tazdevl ... I really appreciate that.

In other news...

Well, I've had my appointment to look into my high levels of eosinophils, and I suppose my instinctive reaction is again to be enormously encouraged for the future.
This was a doctor I've never met before, and in the absence of my usual doctor who is the practice diabetes specialist, he had actually taken the time to read the email that I'd sent in to propose what I though was going on. Not only had he read it, but he had take it all on board, and not simply dismissed it out of hand. I had practiced all sorts of ways of describing the context, in order to have a positive discussion, and not a fight - and it was all more or less redundant, because he was already up to speed before I walked in.

And - he was interested, and willing to listen, and converse with me, rather than just let me speak for a bit to get it off my chest, then diagnose something. We talked through the possibilities; and we agreed on a set of blood tests to do, mainly looking for C-Reactive protein, but also another inflammatory marker that I wasn't aware of.

These eosinophils are very directly connected to asthma, and this doctor let me know that in the UK, it is now possible to diagnose asthma from eosinophil levels alone, so there may still be some connection to me reducing my asthma medication (for the same reason, I just have less need because my underlying inflammation is so much lower.)

But - the key thing for me is that he was open to the idea I was suggesting - that in my case, clearly more fat-adapted - my metabolism clearly shifted to a more fat-burning state; that the role of these cells may have changed. I have a set of tests to do, and will pick it up with my normal doctor when she returns from her holiday.

Interestingly - when I mentioned that it was such a relief not to find myself in a big argument - he said that there was a definite shift going on (and I assume that he meant in medical training, he is a new doctor to the practice) and that it seems that there is much more of a consensus "that sugar really is at the root of many of the issues" and that the focus on fat and cholesterol my not be all it's supposed to be (he never even mentioned that my cholesterol is high), and that there is a much better understanding of metabolism - I really do feel that things are moving in the right direction, and I feel hugely more positive about the general state of health for the future.

Anyway - for me - the next step is that annual review with the diabetic nurse on Wednesday - I'm hopeful, but expecting all this positivity to come crashing down, and finding myself back in an argument about why I've refused statins.

But either way.. this was right up toward the most positive possible outcome..

 

[Outlier]

What excellent news, and what an amazing Dr.! Let's hope in the micro and macro such an attitude will spread into a new understanding to become medics + patients as a team for those who want it (lots of people prefer just to be told what to do).

 

[Chris24Main]

I'm really glad you see it that way - I came out with a real buzz - "this is what healthcare really could be like" - more engagement, more collaboration, not just "tell me what's wrong and give me a pill for it" - I just didn't know whether I could really say that ...

I mean, I could still be hopelessly wrong about all of this, and there is something horrendous going on..

I was just super encouraged by his attitude - maybe it's only that he hasn't been practising long enough to be ground down by the system, but my hope is that medical training really isn't happening in some kind of bubble, and that new doctors are more able to be flexible in their thinking; and of course how much more responsibility we all need to take in our own health - and I say that only looking back a year or so and reflecting on how much my own perspective has changed..

 

[Chris24Main]

A quick one in preparation for my annual review later today, and really because I feel stupidly nervous about it, and I'm trying to figure out why. The best answer I can come to is that it is important for me to feel positive about interactions with the health service.

On many levels - I have been treated in African orthopaedic wards where you have to navigate corpsed in the hallways, and nobody speaks English, and the water isn't safe to drink. (probably much better now, this was decades ago) - but the experience has made me forever deeply grateful for good quality medical treatment, and while I do not think that a sense of blind subservience to medical authority helps; I do strongly feel that anyone working to look after other people should be cherished.

But also - it's important to me - I'm aware of my own biases and placebo effect, and that my own treatment will be most effective if I believe in it - so I want to be aligned with the support I'm getting.

Over all of that - I also feel something of an obligation to leave a positive impression with anyone I come into contact with, so that they are just a little bit more likely to support someone else who believes in grasping the nettle of insulin resistance for themselves.

So - all of this means - I do not want to get into an argument about taking statins.

With the (not entirely resolved yet) issue of eosinophils, every single one of my markers are excellent -

If you look at metabolic syndrome, my HDL is high, and my Triglycerides are low, my blood pressure is low, and my blood glucose is low.

If you look at NAFLD - my visceral fat is low, stable; and my waist-to-hight ratio is better than when I was 18 (a long time ago).

If you look at pure T2DM - my HbA1c is low and steady (there is a case that it's even falsely high because my red blood cells are lasting longer than "the average" three months that the test is based on, but even ignoring that, the numbers are good).

If you look at other health markers for diabetics - I have sensation returning to my right foot, I have skin tags disappearing, and no other symptoms.

If you look at general markers for inflammation - I've been a life-long asthmatic (though never severe) and I'm barely using my meds, because it's barely needed, where a year ago I would notice if I missed a single day. I have various skin conditions (had psoriasis as a youth, and blepharitis recently) - all just gone, and I'm feeling fitter and generally better than I ever remember being.

Mentally - (and this is something we tend not to mention in a diabetes-focussed forum, for obvious reasons; it's more often a struggle for people) - I feel like a totally new person - I just can't remember feeling so capable, positive and free of anxiety.

but - my LDL-C is high, and what I really do not want, is to have all the above ignored, and get into an argument about why I need to take a statin to reduce my cholesterol.

I could explain the Lipid Energy Hypothesis, which posits that in a fat-adapted metabolism (which I can prove that I demonstrate) - there is much more mobilisation of fat, for the simple reason that it's being shuttled into and out of storage for burning throughout the body- and that requires more shuttles... which is what you measure as LDL (these are not "bad cholesterol" - they are complex particles for transporting fat in the form of triglycerides as well cholesterol, which is simply cholesterol, whether it's in an LDL, HDL or any other lipoprotein).

But - if that argument has already started, that's just going to come off as me being a smart-ass.

So - I should maybe stick to the line that all my other markers in my lipid profile would suggest that my LDL particle size distribution is good (big and fluffy) and that they are being recycled efficiently, after all; the most recent research would lead you to worry about cardio-vascular risk only with small, dense and old LDL particles which have become peroxidised or glycated. (much in the same way as sickle-cell anaemia is a direct risk for CVD events).

Or, should I stick with the line that the direct risks for heart disease (as opposed to the associated risks such as LDL-C) are high blood pressure, smoking, chronic inflammation and high stress hormones; and that my current regime seems to be working, so why introduce the risks directly attributed to long-term statin use, such as increased insulin resistance? (obviously the very thing I'm fighting against) - so that my thinking is that while statins may be beneficial for some, I view the risks to outweigh the possible benefits in my case... that still seems like the best way to avoid an argument.

But - I had a look through my medical record - and there is a line - "Patient declined statins"

and - reading into the text -
the direct wording is "prev discussed, patient prefers to do his diet. Aware can ask to try statin if wants".

I think my GP has actually cleverly sorted this out for me. That note is perfectly worded; There is a clear reason why I have declined, it's clearly been agreed, it's clear that I have been made aware that they are still available, and it's clear that using them is a positive choice I can make - if I want.

I don't want - but having this written in this way - I can simply point to my record, and there is no way that anyone, diabetic nurse or not, can turn that into a negative argument about why I should be taking statins.

 

[Outlier]

Wording is much more important than most realise. I think your Dr. has steered a tactful path between warring pressures.

I now have Nursie on board about the statins thing too - took a couple of years - I have the advantage over you in being female (as Nursie is) because the most modern research on statins says it is arguable that women, and older women (that's me) in particular may benefit from higher cholesterol. You can't do this, but I also explained that I wasn't refusing statins to be awkward, and I wasn't ruling out taking them in the future (though I actually won't) but for now would see if I could achieve lower readings from the lifestyle changes I had made. This means Nursie can tick the box that says she has discussed statins and I have refused, so her back is covered. I noted last time that my cholesterol reading wasn't even divided into HDL, LDL and Triglycerides, so eager is the system to show my cholesterol is "high". So - Nursie knows I have researched the most modern findings with proper peer-reviewed information, that I like you am taking an active participation in my health, and says that that my cholesterol readings are probably familial.

It's all a game, but the stakes are high. The key point is to be understanding of medical staff's pressures while keeping a firm handle on one's own health. I reckon you are managing that nicely. Giving "the other feller" a back-covering get-out is part of the negotiation process.

 

[Chris24Main]

Absolutely - and I totally applaud your approach too...

As far as the female perspective goes, simply none - none - of the early studies even featured women, let alone considered whether there might be any difference between the sexes as far as any of this goes. Then, the one major - and most expensive and significant randomised control study ever conducted, ostensibly to prove that a low-fat diet would improve lipid markers and therefore health, concluded that "The diet had no significant effects on incidence of CHD"

Low-fat dietary pattern and risk of cardiovascular disease: the Women's Health Initiative Randomized Controlled Dietary Modification Trial - PubMed

ClinicalTrials.gov Identifier: NCT00000611.

pubmed.ncbi.nlm.nih.gov

Anyway - as much as I was nervous about the appointment going in, I'm more than delighted to report that it went swimmingly...

No concerns, and no arguments - Statins were brought up, but I was amazed that she was prepared to listen to me give the simple version - simply more fat carrying particles in someone who has more fat mobilisation, and I didn't feel they were appropriate - fair enough, and that was that.

She even said she would have to look into intermittent fasting for herself as it was clearly working so well for me (we got into a little bit about how I was really aggressively fasting to start with, but now was mostly just eating from noon to 7pm - which she equated to the Michael Mosely - Fast 800 type of regime; I wasn't going to argue with that...).

Over all, I'm just more and more encouraged that there are signs of a tide turning - as more and more people come into contact with other actual humans who are thriving and turning things around, and just feeling amazing... and for long periods of time - that has to be more impactful than the drip drip of negative press and confusing articles about superfoods...

 

[shelley262]

@Chris24Main thank you so much for this. I'm still waiting for most of this year's results but oddly the nurse this year decided to add in a full blood count and white cell breakdown - not usually included and hadn't had this test for about 10 years! Interestingly just like you a high count of eosinophils has emerged of 1.3 so not in reference range! I wondered what it meant as I have never had asthma, had a recent low CRP and not feeling under the weather. So it was good to hear your theory about them being repurposed. Like you I have high LDL but decline statins as when I took them they made me ill. We already had the cholesterol discussion yesterday as it's been high for 9 years now so know it will be high again this year it's just how high! Interestingly I participated in a cardiovascular study three years ago as a person in remission from type two diabetes looking at cardiovascular risk. I had a day of lots of heart health tests including MRI and a Calcium score scan. My results looked promising including a CAC score of zero. this has helped me to make decisions about statins but nurse couldn't resist saying yesterday that I didn't know what it would be like three years on with another three years of high cholesterol!

 

[Antje77]

A quick one in preparation for my annual review later today, and really because I feel stupidly nervous about it, and I'm trying to figure out why.

I came here to wish you luck on your appointment, and on the nerves on your appointment today. You sound like me, having almost perfect numbers for almost anything, and still nervous enough to need extra insulin before my yearly appointments, even though I know my endo is perfectly happy with my approach.

Anyway - as much as I was nervous about the appointment going in, I'm more than delighted to report that it went swimmingly...

Very glad to hear the luck wasn't needed, and that your appointment went as well as mine always do, despite nerves!