Targetting Insulin Resistance vs Glucose Intolerance

ickihun said:

Take metformin. It has great affects on my insulin resistance.

Once researchers know everything about metformin and how it helps IR then we'll know more..end of.

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I stopped Metformin a few months ago.

I didn't stop it because I think it's a bad thing, in fact I could tolerate it well (no obvious side effects), plus there's plenty of studies which suggest it could be a wonderful thing even in ways not intended.

Right now I'm working out to what extent I can get my body ticking along safely without it. Weight loss is having such a measurable effect that I want to get down to my lowest comfortable weight while not being on medication, to see what the results are.

I have no objections to going back on Metformin. If I can't reliably get safe bg levels naturally, then I'll definitely be back on it. Even if I can, I'll be tempted to go back on it in order to increase my safety margins.

Mbaker said:

@AdamJames I a version of lifestyle I would recommend based one what I have been through. This is a quick summary of my experience since January 2015. Initial drop from 20+ to 16 mmol in one week by watching carbs (should have kept on this road with a 20% drop whilst still not eating right for me (home made banana cake)). Started on Metformin, 1 then 2 tablets. Embarked on a low GI diet of soda bread, oily fish, oats made with milk, sweet potato. I cut out items that were clearer to my wife and I to be carby (potatoes, pasta and rice). I then did a biggest loser amount of workouts, often with my heart rate at circa 145 bpm. This got me just under diabetic numbers, this was hard but easy. To explain I used to do a lot of sports so found working out quite easy (but exhausting) - this is not an efficient route to getting in remission, but did work for me; but I would question sustainability.

I finally found this site and just read for months, discussed concepts with my HCP wife. It was hard for her, as to hear the ideas were against what she had learnt (twice), imagine that. I was open, as I was cross referencing, but still could not get my head around fat.

The best move I made was moving to LCHF from low GI. I experienced instant further weight loss and a lower HbA1c and the euphoric feeling people talk about. I was eating 3 meals a day and feelings stuffed, so went down to 2 meals. I have tested several additions such as heavy weights using HiiT and walking further and slower. I began to understand that diet is most important aspect (in my opinion) on this journey, with exercise as the cherry on top.

LCHF is a fix in it's own right, but is a conduit to Keto and intermittent fasting. Yesterday I had to cancel breakfast at a hotel I was staying, as the day before I ate 2 meals and was still full. I am now OMAD adapted, which all started due to LCHF setting the scene for a lesser requirement to eat. I weigh 85.5 kg now which is my lightest for maybe 20 years, maybe longer, and my visceral fat has moved to 6.5% with total fat of between 11 and 13% depending on which of the 3 scales is used. I respect other protocols, but for someone wanting to resolve metabolic issues I would do the following (no snacks):

1. LCHF (3 meals), moderate exercise
2. LCHF, IF (2 meals), moderate to medium exercise
3. LCHF and Keto (1 to 2 meals), IF, moderate to medium exercise
4. Keto, IF (1 meal) , moderate to medium exercise

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Thank you, I really appreciate that write-up.

My own experiences / experiments in the last few months lead me to one of the same conclusions as you: diet is the most important thing, and exercise is the cherry on top.

We sound similar in that in spite of being diagnosed with a metabolic disorder, we have a reasonably "fit" background and our bodies work pretty well in many regards. Just yesterday, after only about 900 calories, I did 2.5 hours strenuous walking up and down hills with a very heavy rucksack. I'm not athletic and didn't find it "easy", but I'd say it was "no problem".

I've just woken up now and it has had the desired effect on my morning bg. I'm currently doing an experiment to see what other effects it has. So far my limited data tells me that it sets me up nicely long-term - I can go straight back to having roughly maintenance calories and the levels keep low.

I haven't yet used that level of calorie restriction on a long-term basis (ND style), just a week max in the past. I'm considering an ND approach, but am not totally sold on the idea. IF is increasingly appealing, and your plan sounds excellent. I speculated earlier in this thread whether one meal a day with very few carbs might be "optimal", though I was thinking also in terms of big calorie restriction for weight loss.

By all accounts the calorie restriction isn't necessary (at least consciously) on LCHF / IF, but everyone is different, I haven't verified that for myself yet. I suspect my ability to eat excess calories even on a keto diet might be legendary! I did go VLCHF for a week, totally embracing the fat (double cream on nuts for breakfast, belly pork for dinner with just some sprouts, that kind of thing!) and my main finding was that all food is like crack cocaine to me, not just carbs!

Right now I'm still hung up on the simple ideas of calories and body fat, because my own data is telling me they are the two main variables influencing things.

Having lost a few stone, my fasting bgs seem to now have a lower "set point" when maintaining/slightly gaining weight. Many times now I've tested this. While overall doing great work losing weight and lowering my HbA1C, I'm often quite reckless short-term. But I gather data even when I'm reckless, rather than saying "this is a blowout that doesn't count". One day I had about 4000 calories with 300g carbs, another day I had 4000 calories with 40g carbs, another day I had - wait for it - 5600 calories with 525g carbs. The set point the morning after was the same in all cases. Too high, but much lower than when I had more body fat. Even the individual food spikes weren't as drastically different as one might expect, which I guess is due to the "last meal effect" - while having much less carbs, it takes less carbs to cause a spike, if you see what I mean.

And so far, being in a *state* of weight loss, i.e. restricting calories, which I'm guessing means having a liver depleted of excess fat and glycogen, means bg control is better both in terms of fasting levels and spikes after food.

Obviously this state of weight loss can't go on forever. And it hasn't so far - I've mixed up weight maintenance, rapid weight loss and gradual weight loss for months. In terms of carb levels, when I'm not being reckless, which is probably 95% of the time, I'd say I've been "carb-conscious" rather than "LCHF".

Once I can't use weight loss as a tool any more, approaches such as yours are going to be top of my list. Possibly well before that.