Type 2 Trifecta: T2D, CKD, and CVD; want to go low carb

[espe.ranza]

Hi to all,
I'm new to the forums, posting here for a an elderly family member (75) who refuses to join me online to do research about her condition: the terrible trifecta of T2D, chronic kidney disease (stage 4), and CVD. I have done some searches here on the forums, but it's not easy to find answers specific to my questions.

I am hoping to persuade her to adopt a keto diet for 3 months, just to see a change in numbers. Her A1C level is currently at 6.4. She is extremely resistant to give up carbs completely, even for a limited time.

Our discussions go in circles: I say keto will help wean her off the diabetes pill and lower her aic even further; but she says the problem is the CKD. I then point out that emerging studies indicate a benefit to the kidneys once sugar is removed from the equation, and she says, well the main concern is my heart. So then we watched the David Diamond lecture on cholesterol (from 2015) and this has convinced her to have a conversation with her GP about reducing all those meds. But then she freaks out about the high BP, even though it's not THAT high (around 145/85). When I say that studies suggest keto also lowers BP, she goes full circle back to the sugar and unfounded fears of hypoglycemia.

She insists on seeing her doctors first, which of course I support, but she is highly resistant to reading or watching anything to help her have a more informed conversation with the doctors. I was able to get her to listen to one Jason Fung podcast, which made her think (for the first time in a long time) that change/improvement may still be possible. And we watched together the Diamond lecture, which has assuaged somewhat her fear of fat. I think Peter Attia's lectures are good, but likely too technical for her to follow. She has a limited attention span and I can manage 1-2 interventions/conversations per day.

And so I'm focusing my energies on two areas right now:
-the impact of keto on blood pressure
-concerns related to CKD

Another factor is that she is thin (5'5"; 112 pounds) and has never been obese. Much of the conversation to do with keto and low-carb diets is overwhelmingly about the Standard American Diet and weight reduction---neither of which really apply to her, though she has consumed a fair amount of whole food carbs most her life: brown rice and whole grain bread (but not processed junk food).

Can anyone suggest resources/sites or videos I can go to that will address the keto diet in relation to the trifecta of BP/CVD/CKD, but without the sole emphasis on weight loss?

I have very much appreciated the community here and the wealth of information and support.
thanks!

 

[Brunneria]

I can tell from the effort you are making and the interest you have in this, that you care very much for her. But I have to warn you that you cannot force someone to change. And I am afraid that is what it looks like you are trying to do.

Changing eating habits is incredibly difficult. We see it on the forum here all the time. Someone wants to change the habits of a lifetime, and is convinced that they need to change. Yet even though they want to change they still struggle.

The person you describe is trying to avoid change and resist the pressure you are putting on them. Their excuses and concerns show this clearly. By changing the argument and coming up with reason after reason the are clearing showing that they don’t want to change. This will always be their choice to make. From what you say it looks as though they are afraid of change.

I don’t know if you live with this person and prepare all their food? But even if you do, you simply cannot enforce a keto way of eating on someone. Apart from the ethics, and their right to choose what they eat, you cannot be there every time they go out, have a coffee, see friends... keto requires commitment, understanding and enthusiasm, which I do not see coming from your family member (from your description).

Can I suggest that you think very carefully about what you are doing. I would urge you to preserve the loving relationship you have with this person by not making this into a barrier between you. Let them make the choice of whether they will join you in eating keto. Do not try and push them into it. Stop convincing them. Stop pushing them. And if they decide to continue eating carbs, then let them do it with love and non judgement.

 

[ianf0ster]

Hi espe.ranza,
While I have no experience of CKD, I am a T2D who has had a 3x CAB ( before my diabetes diagnosis).

Also I am slim and the most I have been 'overweight' was by around 2lbs.

I reduced/control my Blood Glucose by Low Carb High Fat eating with some skipping Breakfast = Intermittent Fasting (IF) if my BG is 7.8 or above. My HbA1C figures and Lipid figures are in my signature below.

Personally although I do low carb enough to go in and out of Keto (I eat between 20 to 50gms Carbs per day) I feel that rather than go straight into Keto, it may be better to just eat to the Blood Glucose meter - that way the user discovers which carbs as well as how much of them, cause the high BG and spikes.

However as Brunneria says, you can't force somebody to do something even if it actually is in their best interests. And it is probably more important to preserve a good relationship than to try to impose good health on them.
I have friends who are mildly obese, who express a slight interest in what I eat when out for a meal with them. They can see me avoiding Potatoes, root veg, rice, bread, ketchup etc. and can see that I have lost around 10% of my weight at T2D diagnosis. They are a little curious (or perhaps the are just being polite). But they have never asked for dieting advice, nor would I pressure them on that subject.

 

[KK123]

Hmmmm, I may be in the minority here but I say leave her alone! She is 75and although she seems to be making an effort to listen to your views, she clearly does not want to go keto. Why should she? Maybe she is happy eating fewer carbs than she would normally or maybe she isn't. I'm not saying people who get to 75 shouldn't bother because she could have another 20 years to go or she could have another 5. Either way, she has to choose a strategy that she is happy with. If someone paid that much attention to MY life and choices at 75 I would be furious. I know it's out of love but you should know when to back off. Continue to support her of course but in the end she is NOT a baby and it's her choice. You run the risk of her dreading your visits.

 

[ianf0ster]

I have just seen this video, perhaps it at least starts out at the right level for her.

https://www.diabetes.co.uk/forum/th...-reverse-type-2-diabetes.168900/#post-2148974

 

[Rokaab]

Agree with whats be previously said, you can't force someone to change their eating habits if they don't want to.

Also if she's taking anything that actually reduces her blood sugar then this could easily cause hypos.

An HbA1c of 6.4 whilst not non-diabetic isn't that bad, it's in the prediabetic range (and as a Type 1 I'm very happy I've got to around those numbers recently - until recently I wasn't even close to being that low - I realise she is not Type 1, but just putting things into perspective here )

 

[espe.ranza]

Thanks to everyone for your input!

I certainly do not intend to force her to go low carb, but what I do want to do is make sure she is informed in her decision. Right now she dismisses the very idea of low carb diets as dangerous quackery. She resists even listening to alternative approaches. That she watched the Diamond and Fung videos gives me some hope that she might be open to hearing more.

This became more urgent recently because of a sudden acceleration in the decline of her kidney function, from stage 3 to stage 4. After going through mandatory classes for dialysis patients, she insists that she will refuse dialysis. I simply want to show her that a few key diet shifts could possibly stall her rapid decline into stage 5 and the dialysis decision moment. Her conventional doctors are being very, well, conventional in their recommendations.

She lives with my sister. I currently live 3000 miles away but visit often. At the moment I am on leave for work, so I could help her understand and work through some lifestyle changes in person. In fact, I've been modeling a fairly low-carb diet myself while I am here, not eating bread, rice, etc, and sharing my dishes with her. It would not be easy, but I could probably extend my leave significantly if she proved willing to consider further changes.

My goal here is to find some accessible resources to share with her---and which address her issues from a non-weight-reduction perspective (or at least address her non-obesity history). I am very grateful for the supportive advice.

 

[espe.ranza]

Just posting an update: after several more days (occasionally contentious) of further reading, discussion, and video-watching, she got on board with a full keto program. She was still suspicious and doubtful, though, so we visited her doctor, who does not generally approve of the ketogenic approach but, based on the bloodwork, gave a cautious green light to try it for three months, as long as we consult with a naturopath. We found one who has been doing keto for three years and is knowledgeable and sympathetic.

For a week now, she's kept to a 20g carb-limit and 130g fat quota (to avoid losing any more weight). She's in moderate ketosis at this time. This has upended a lifetime of eating habits, to be sure, and we've had some difficult days, emotionally.

The GP said they were open to having their mind changed about the diet if all the test results improve. This looks promising, as she is already off all diabetes meds and sleeping better, feeling better, and is more energetic overall. We are now walking for an hour daily, when before she barely wanted to get out of bed. We have an order to re-do all the blood and urine tests in mid-January. I'm feeling very optimistic. More importantly: for the first time in a long time, she has shown optimism, and we are planning a short road trip with easy scenic walks for the spring.

PS: I am doing the diet alongside her, and I am now in full ketosis myself.

 

[ianf0ster]

Good for you.
You appear to have negotiated that narrow path between not trying hard enough and of trying too hard.