Why won't the NHS tell you the secret to treating diabetes?

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zand

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@Tannith @Beating-My-Betes
Re thermodynamics. What happens if you put less and less fuel on a fire? Does the fire still burn the same or does it give out less heat? What happens if you let the fire die down so low that even putting on more fuel does nothing to revive it? I well remember being told off as a kid for letting the log fire go out because I didn't keep it stocked up with the right fuel.

So isn't this what very low calorie diets do to our metabolism? Effectively damp down the fire? This is what happened to me when I followed them and my metabolism has never fully recovered.

Now, have you ever thrown the wrapper from a block of butter into the open log fire? Instant energy! Throw enough fat wrappers in and the wood logs that had gone out come alight again. That's what happened to me when I added fat (and therefore calories) and reduced carbs. It's all about thermodynamics don't ya know? You need energy to burn the existing unused energy that the fire can't burn and the fat wrapper kickstarts the fire.

If you put the right type of calories in you get the right metabolic effect. As diabetics we are carb intolerant, so let's not put petrol into our diesel engines eh? Or we could carry on cutting down on fuel and expect the engine to work well running on almost empty. I go for butter by the slice, not bread, that's thermodynamics for you. :)
 

Daphne917

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Low cal is not the same as low carb. The two are "methods" of doing two totally different things. Low cal can reverse T2 whereas low carb can only lower blood sugar, (which can also be done with drugs like metformin). I am looking to REVERSE my T2. Just temporarily lowering blood sugar is not my goal. And the OGT measures beta cell function because it measures the body's SPEED of response to glucose, rather than just the total amount of glucose you have put into your blood by swallowing it (or not swallowing it, as in the case of low carb)
@Tannith what are you going to do once, and if, you manage to reverse your diabetes? Go back to eating ‘normally’ and risk being back where you started or try and maintain a non diabetic blood level? I have had a normal hba1c for approx 7 years and eat about 120g carbs per day; My FBS mostly ranges from between 4.4 and 5.6 yet, according to my DN, I am not in remission only well controlled. I believe I am in remission and the new GP I see in the practice believes I am no longer diabetic however, I would not like to risk increasing my BS by eating the same amount of so called ‘normal’ healthy foods such as wholemeal bread, pasta, rice, potatoes, low fat yoghurts, spreads etc and fruits such as bananas that I was before. As you can see from my carb intake I do still eat some of these but in moderation.
 
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bulkbiker

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But Tannith is right when referring to thermodynamics. These are unbreakable laws of energy.

Sorry but our bodies are far from being a closed system.
The first law applies to closed systems like bomb calorimeters.

You rightly say that you cannot control used calories which is why calorie reduction leads to RMR slowing.

Changing what you eat is far more beneficial as it harnesses our hormones to help us rather than hinder which is what @Tannith s experiments in starvation show.
 

oldgreymare

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You can ONLY lose weight with low carb if you use it as a low cal diet. If you don't replace the missing carbs with extra calories from fat then of course you reduce your calories and lose weight. But simply changing the macronutrient from which you derive your calories cannot cause weight loss, only lower BG.
Can you supply any independent research references to support your opinion?
 
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oldgreymare

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It still comes down to calories in vs calories out. The reason it seems otherwise is because people mistake calories in as being measured at our mouths. But in reality, both calories in and out are a 'bottom-line' equation. After all the questions of satiety, dietary compliance, nutrient absorption/malabsorption and whether the body ramps up metabolism, increases heat or forces us to fidget via N.E.A.T, to burn any excess energy off, one is left with a number that is balanced against our actual/real caloric expenditure. An energy deficit will lead to needing to borrow from stored energy (fat and muscle bank), and an excess will allow one to make an energy deposit, to be used for another time.

Because we can't accurately measure the absolute calories in food, nor the energy that is lost through the various processes and inconsistencies, or the fact that us lay people certainly can't accurately measure our caloric expenditure (not to mention that none of this is neatly calcualated by the body in 24-hour time packages), it can seem like calories in/out does not compute. But Tannith is right when referring to thermodynamics. These are unbreakable laws of energy. Which is fortunate, because we'd never have survived as a species were it not for our ability to store and burn excess energy, at the appropriate times.
Agreed. But as you say, the simple laws of thermodynamics that work well in a laboratory calorimeter do not easily account for the treatment of calories from a large amount of messy interactions from enzymes, hormones, gut bacteria, and more within a living organism - all of which may lead to many different and variously efficient routes of ATP and mitochondrial metabolism. So calories in, calories out is not particularly useful to help plan for many individuals for practical lifestyle management - they need to consider many other factors.
 

lucylocket61

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CICO doesnt take into account the different response to carbs for a type 2 diabetic.
 

Beating-My-Betes

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If our bodies were simplistic mechanical devices, then I might agree with you, but our bodies have an innate intelligence that regulates all the processes in our bodies better than the computers in the Space Shuttle.

Fortunately for those who have been flung out into space, NASA's computers are way more precise :) The human organism is absolutely a marvellous thing, but it is also pretty flawed.

The body seems good with ranges (e.g temperature or acid/alkaline balance) and relative values, but not so good in terms of absolutes. An apropos (for this forum, at least) example would be false hypos i.e When one's body has made a 'new normal' of elevated blood sugars, such that a low can occur even when sugars are actually still really high (I've experienced false hypos at approx 170 mg/dl - 10 mmol/L). Weight set-point theory is another probable (I'd suggest definite) set of feedback mechanisms that will cause the body to defend a particular weight, even if that weight happens to be hundreds of pounds heavier than a healthy weight for our body. I actually believe that set-point is the root cause of why most diets are doomed to fail, unless the appropriate weight is held for long enough for the body to recalibrate to the improved 'normal'. I mention SPF because it relates to something you write, further down in your reply.

While our food transits the intestines and colon, our body controls how and when it collects nutrients from the gut and usually this process is responding to another set of demand./ saity enzymes that alter what we accept from the food stream. Most of our meal appears at the other end and gets discarded. We know this contains the macronutrients from the meal since it can be placed into a sludge digester and produce methane which we can burn for energy, It also can be used as a fertilizer so has other nutrients still in the mix that did not get grabbed. So the calories-in does not represent what actually gets passed into our body for use.

Which is what I tried to explain in my answer. Calories-in is the measurement of what actually does get passed into our body for use. The confusion comes because everybody seems to measure it at our mouths. Our bodies have no interest in the fact that the pizza box says that the meal is 1000 calories. It only knows what is left as usable energy once all these other processes have played their role.

An analogy would perhaps be the difference between our quoted salaries and the amount of cash in our wallets, that we can actually spend. Someone may earn £2000 a month. But after Tax, National Insurance, Investment plan costs, monthly insurance deductions and payments of rent, utility bills etc. only then can we see how much available money (or financial calories) are usable by us.

We have now established that this is true of glucose, and also for lipids, so that fat in does not usually equal fat gain for example.

Of course it doesn't. No single macronutrient, or combination thereof, will result in fat gain. Fat gain will only occur if you eat more energy than you burn

If it did then I would be severely obese instead of skinny.

Right. But there are an awful lot of people that believe that carbs cause weight-gain, regardless of quantity.

I eat a high-fat diet, but my weight has been static for 5 years now and my BMI is 21.

"High-fat" is a relative term. Nothing about eating high(er) fat would suggest weight-gain, unless you were exceeding your energy needs. A cup of olive oil has 1900 calories of fat. For a six-foot-seven male in his twenties, that amount of energy would lead to weight-loss. For a 15-year old, male at five foot, it would lead to weigh-gain.

I am a pensioner who is a couch potato in lockdown, but my mass is still unchanging whereas the CICO mantra states I should be ballooning.

No! CICO is simple energy equation. Couch-potato-ism is irrelevant, unless it leads your output to fall below your input.

I used to weigh nearly 17 stone, but after I started LCHF for my blood glucose control, I have dropped to 10 stone and stay there within 1 kg. My wife shared my diet, and she dropped from 18 stone to just over 9 stone at the same time. My waist lost 6 inches of girth as a result. So for me, Low Carb lost weight and gave me control of my BGL. I have never counted a calorie in my life. I do not even count carbs and I do not starve myself.

When asked which is the best exercise to take up to become fit and healthy, experienced PT's will often answer "The one you are able to stick to". It's really the same with diet. There is no magic bullet or metabolic advantage that makes a high-fat or keto diet more effective for weight-loss. We have examples of people losing weight and improved markers on a diet of McDonalds (https://metro.co.uk/2018/11/13/man-...ng-nothing-but-mcdonalds-for-30-days-8134563/) or on cakes , Doritos, Oreos etc. (https://edition.cnn.com/2010/HEALTH/11/08/twinkie.diet.professor/index.html). And many, many people who have ditched pounds and regained health by eating less and moving more.

If you are eating less than you burn, your body will start plundering reserves, whichever diet you choose. Ketosis can, for many, help by quietening/dampening hunger signals, but this really only speaks to compliance. And it doesn't always work for all people.

As for your effortless weight-maintenance? I also have effortless weight-maintenance. I've been the same weight, give or take a few kilos, for well over a decade. I don't need to count calories (Though i have done occasionally as a part of ensuring macro and micronutrient sufficiency). If I eat to satiation, I maintain my weight. Unfortunately, the weight my body is fiercely defending, and leveraging hormones to do so, is 117 kilos. That's correct. My body is doing everything it can to keep me at a weight that would, without an ongoing concerted effort, eventually kill me. So much for our bodies having an "innate intelligence" ;)

Either way, I'm glad you and your wife have got down to a healthy weight. I'll be there in no time, albeit using a diametrically-opposed approach.
 

Beating-My-Betes

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Re thermodynamics. What happens if you put less and less fuel on a fire? Does the fire still burn the same or does it give out less heat? What happens if you let the fire die down so low that even putting on more fuel does nothing to revive it? I well remember being told off as a kid for letting the log fire go out because I didn't keep it stocked up with the right fuel.

Of course, putting less fuel on the fire reduces the heat. Why would we not sometimes want to reduce the heat? I'm coming up to three years of daily cold showers. On colder Winter days, I like to pre-warm my bedroom so i can return to a warm room after my frigid shower. For the first couple of minutes, I put the heat (portable gas fire) on maximum, after which I drop it from three bars to one, and just let it simmer at that heat for a while. Toasty :)

Also, in looking to fuel specific activities, would you use the same amount of fuel to run a 10k race as to fuel a Netflix binge-a-thon?

So isn't this what very low calorie diets do to our metabolism? Effectively damp down the fire? This is what happened to me when I followed them and my metabolism has never fully recovered.

I guess you are more referring to Tannith, in this case, as I am not advocating for a very low-calorie diet. That's not to say that people can't have success with very low-calorie diets, and without any longterm metabolic repercussions.

I'm curious to know about your longterm metabolic issues, if you are happy to share.

Now, have you ever thrown the wrapper from a block of butter into the open log fire? Instant energy!

Not thrown butter on the fire, though I'd certainly prefer doing so to eating it ;)

As for instant energy, I'll defer to cyclists and long-distance runners. In all but a few cases of fat-adapted athletes, instant energy comes from simple-sugars and generally refined carbs, whether from gels, Cocal-Cola, sugar-water or good ol' fruit.

Throw enough fat wrappers in and the wood logs that had gone out come alight again. That's what happened to me when I added fat (and therefore calories) and reduced carbs. It's all about thermodynamics don't ya know? You need energy to burn the existing unused energy that the fire can't burn and the fat wrapper kickstarts the fire.

I'm gonna speculate that you had no idea of how many calories you were eating before you cut carbs and so do not have any relative data for the differences when you switched to fat. But I'd love to see some data if you have it.

As for the idea that "You need energy to burn the existing unused energy that the fire can't burn and the fat wrapper kickstarts the fire."? We know that in the total absence of calorie intake, e.g in extended water-fasting or literal starvation that our bodies lose weight. It's a natural part of our survival mechanism to burn reserves when presented with times of famine (either genuine or self-imposed). Nothing need happen to 'kickstart' any 'fire'. Evolutionary survival mechanisms have no need for packets of butter :)

If you put the right type of calories in you get the right metabolic effect. As diabetics we are carb intolerant, so let's not put petrol into our diesel engines eh? Or we could carry on cutting down on fuel and expect the engine to work well running on almost empty. I go for butter by the slice, not bread, that's thermodynamics for you. :)

Right type of calories? Right metabolic effect? Carb-intolerant?

Do you mean insulin-resistant? Certainly, the majority of this community seems to favour a very-low-carb diet, but I have seen members here who have tended to favour a moderate-carb approach. (I believe AndyDragon has just confirmed remission on a 100-120g carb diet. I could be wrong). And there is an ever-increasing group of diabetics, outside of DUK, who are getting their BS under control by eschewing fat and eating carbs ad-libitum.
 

Beating-My-Betes

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Sorry but our bodies are far from being a closed system.
The first law applies to closed systems like bomb calorimeters.

I'm agreeing that the human body is not a closed system. I'm also using the term calorie as interchangeable with energy. We don't need calorimeters to show us what we already know i.e that excess consumption of external energy, past our energetic expenditure, will lead to storage and underconsumption of external energy, under our energetic expediture, will lead to burning of stores.

'Feast and famine' is a tale as old as time, and our ability to fatten up in times of abundance and plunder those stocks in times of scarcity has been fundamental in our up-to-this-point evolution, but also why we are primed to become obese within our current dietary environment.

You rightly say that you cannot control used calories which is why calorie reduction leads to RMR slowing.

Slowing of RMR is a natural response to reduced energetic needs from lost weight. But it is also the body's first line-of-defense against unnecessarily plundering reserves that it has sequestered for times of famine. It doesn't take much to break through that barrier and force the burning of stored energy.

And to clarify, I'm not particular referring to huge caloric-restriction, but consistent and manageable deficits.

Changing what you eat is far more beneficial as it harnesses our hormones to help us rather than hinder

Changing what we eat is likely a good idea, as most people who get overweight do so with diets not particularly well-aligned with health. As for harnessing hormones? If it helps you, then go for it ;)
 

lucylocket61

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I'm agreeing that the human body is not a closed system. I'm also using the term calorie as interchangeable with energy. We don't need calorimeters to show us what we already know i.e that excess consumption of external energy, past our energetic expenditure, will lead to storage and underconsumption of external energy, under our energetic expediture, will lead to burning of stores.

'Feast and famine' is a tale as old as time, and our ability to fatten up in times of abundance and plunder those stocks in times of scarcity has been fundamental in our up-to-this-point evolution, but also why we are primed to become obese within our current dietary environment.



Slowing of RMR is a natural response to reduced energetic needs from lost weight. But it is also the body's first line-of-defense against unnecessarily plundering reserves that it has sequestered for times of famine. It doesn't take much to break through that barrier and force the burning of stored energy.

And to clarify, I'm not particular referring to huge caloric-restriction, but consistent and manageable deficits.



Changing what we eat is likely a good idea, as most people who get overweight do so with diets not particularly well-aligned with health. As for harnessing hormones? If it helps you, then go for it ;)
When are you going to stop giving information for those who have working systems, and start taking on board the comments and lived experience and differences for those with insulin challenges, and a different reaction to carbohydrates?

You are giving no credence to the issue being addressed, in your replies. Information for those who do not have insulin issues is not relevant or applicable to those who have such issues with carb consumption.

And you havent yet answered what sort of diabetes you have or why you are on this forum.
 
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Beating-My-Betes

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Agreed. But as you say, the simple laws of thermodynamics that work well in a laboratory calorimeter do not easily account for the treatment of calories from a large amount of messy interactions from enzymes, hormones, gut bacteria, and more within a living organism - all of which may lead to many different and variously efficient routes of ATP and mitochondrial metabolism. So calories in, calories out is not particularly useful to help plan for many individuals for practical lifestyle management - they need to consider many other factors.

I agree. But if we accept that all of these different processes can't be accounted for (at least by us lay-people, in our kitchens and on our bathroom scales), then it's helpful to focus on energy balance as a separate idea.
And while many individuals will not take well to weighing food etc. to judge calories, it does work for many who commit to doing it properly. I've done it. It's a pain. But it did work when I did it.

If bacon and eggs is what it takes for someone to make a success of a diet, then that's what they will be successful doing. Others decide to eat nothing but potatoes to engineer their energy deficit:

https://www.today.com/health/spud-fit-man-loses-weight-eating-only-potatoes-year-t106144
 

Beating-My-Betes

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When are you going to stop giving information for those who have working systems, and start taking on board the comments and lived experience and differences for those with insulin challenges, and a different reaction to carbohydrates?

You are giving no credence to the issue being addressed, in your replies. Information for those who do not have insulin issues is not relevant or applicable to those who have such issues with carb consumption.

And you havent yet answered what sort of diabetes you have or why you are on this forum.

I have type II diabetes, currently weigh 116 kilos. I started a 'program' 6 weeks ago, in which I decided to up my carbs to an average of 4-500 grams-a-day, and cut fat to around 10% of my calories, maintaining a macronutrient ratio of 80% carbs/10% protein/10% fat i.e essentially making my macronutrient ratio the diametric opposite of those on a ketogenic diet.

I started the program at 119 kilos, and for the purpose of trying to determine the effect of macro allotment only, I tried very hard not to lose any weight (Drastically cut exercise/walking). Despite that, I have managed to somehow lose 3 kilos on my 450g carb diet, which has included daily rice, bread and potato meals, along with occasional fizzy drinks and sugary tea.

My first day home OGTT was scary. Before testing I was at 14mmol/L and within 1 hour was literally off-the-charts (so high, my testing kit couldn't track it).

Suffice to say, I am coming from this whole discussion, and even my membership of this community, from a position of being absolutely diabetic, and extremely insulin-resistant. What I am trying to be is true to the experience of countless others who have paved the way before me; those who have gone from various incarnations of huge metabolic damage, including with diabetes, to healthy, thriving high-carbers.

So I apologise if it comes off as me being unsympathetic. I'm not. I'm not in any way claiming I am correct in this. Just trying to have a discussion with others who want to discuss these concepts, hopefully to the betterment of mine and others' knowledge.
 

lucylocket61

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I have type II diabetes, currently weigh 116 kilos. I started a 'program' 6 weeks ago, in which I decided to up my carbs to an average of 4-500 grams-a-day, and cut fat to around 10% of my calories, maintaining a macronutrient ratio of 80% carbs/10% protein/10% fat i.e essentially making my macronutrient ratio the diametric opposite of those on a ketogenic diet.

I started the program at 119 kilos, and for the purpose of trying to determine the effect of macro allotment only, I tried very hard not to lose any weight (Drastically cut exercise/walking). Despite that, I have managed to somehow lose 3 kilos on my 450g carb diet, which has included daily rice, bread and potato meals, along with occasional fizzy drinks and sugary tea.

My first day home OGTT was scary. Before testing I was at 14mmol/L and within 1 hour was literally off-the-charts (so high, my testing kit couldn't track it).

Suffice to say, I am coming from this whole discussion, and even my membership of this community, from a position of being absolutely diabetic, and extremely insulin-resistant. What I am trying to be is true to the experience of countless others who have paved the way before me; those who have gone from various incarnations of huge metabolic damage, including with diabetes, to healthy, thriving high-carbers.

So I apologise if it comes off as me being unsympathetic. I'm not. I'm not in any way claiming I am correct in this. Just trying to have a discussion with others who want to discuss these concepts, hopefully to the betterment of mine and others' knowledge.
how many calories are you eating a day on your plan? how are your blood sugar levels doing? what was you HbA1c before embarking on this diet, and what was it on diagnosis|? How long since diagnosis?

I ask these questions as your results will be hard to interpret without that information.

I admit, I have never met any type 2 diabetic who is a healthy thriving high carber unless they have also had many meds too, or anyone eating the way you are, so this is very interesting stuff. What meds are you on?
 

bulkbiker

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I have type II diabetes, currently weigh 116 kilos. I started a 'program' 6 weeks ago, in which I decided to up my carbs to an average of 4-500 grams-a-day, and cut fat to around 10% of my calories, maintaining a macronutrient ratio of 80% carbs/10% protein/10% fat i.e essentially making my macronutrient ratio the diametric opposite of those on a ketogenic diet.

And how's that going for you?
 

lucylocket61

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I find it fascinating how some people dont seem to realise that dietary advice and outcome for type 2 is very different for type 1 or those on inulin, those who are not diabetic. So they follow non-type 2 advice and quote it, and dismiss or ignore that type two are different.

This is a general comment, aimed at no-one, simply a reflection on this thread in its entirety, from my own personal viewpoint.
 

Beating-My-Betes

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how many calories are you eating a day on your plan? how are your blood sugar levels doing? what was you HbA1c before embarking on this diet, and what was it on diagnosis|? How long since diagnosis?

I ask these questions as your results will be hard to interpret without that information.

I admit, I have never met any type 2 diabetic who is a healthy thriving high carber unless they have also had many meds too, or anyone eating the way you are, so this is very interesting stuff. What meds are you on?

Been eating anywhere between 2200 and 3000 calories per day.

Not sure on my Blood sugar levels. They were trending down, with few bumps here and there. I can't afford to test too often, but also I don't want to be bound to the meter. Too many variables to contend with. Just trusting the process. Last I knew, I was testing at FBG of 9, as opposed to a reading of 18, which i saw at the beginning of January.
Did fall off plan for a while, but been better recently. Will test again, soon.

I don't know my HbA1c as i don't get tested at my doctors. Haven't been tested since my diagnosis of pre-diabetes a few years back.
 

lucylocket61

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Last I knew, I was testing at FBG of 9, as opposed to a reading of 18, which i saw at the beginning of January.
The significance of a reading depends on when it is taken. A reading before food, after food, what food was eaten, and how much time has elapsed since the meal.

Basically you are making dietary decisions based on very little information, and with no meaningful testing to see it's effect.

I wish you the best.
 
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Beating-My-Betes

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And how's that going for you?

Seems to be going well. I fell off the wagon for a while, and veered towards a pretty bad mix of high-carb and high-fat. But that seems behind me. Don't get a heavy feeling of doom anymore, after eating a meal. But i've pretty much cut out all the junkier, pre-packaged vegan foods (No more vegan cheese, and only the occasional vegan burgers etc.). Went from having multiple weekly takeaways to one, in the last six weeks. Reduced salt from way over the recommended dose to about 1g (400g Sodium), and now have saturated fat at only a few grams a day.

Sleep quality is a lot better, though stress about certain things is keeping me awake more than i should be. Last remnants of arthritis-like symptoms is starting to clear (Freed up much of that going vegan, but a junk-food vegan diet kept some of it around). Still need to work on hydration, although with much lower salt I feel that's already improving.

Next stage is to start adding in more fruit and dialling back grains. At that point, will start ramping up exercise to a much greater level, and go all-out for weight-loss. Have gone back to incorporating some intermittent fasting. Not back to OMAD, but I pop a few 16-8's each week, and walk to force mini-hypo episodes.

All part of the fun :)
 

HSSS

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Been eating anywhere between 2200 and 3000 calories per day.

Not sure on my Blood sugar levels. They were trending down, with few bumps here and there. I can't afford to test too often, but also I don't want to be bound to the meter. Too many variables to contend with. Just trusting the process. Last I knew, I was testing at FBG of 9, as opposed to a reading of 18, which i saw at the beginning of January.
Did fall off plan for a while, but been better recently. Will test again, soon.

I don't know my HbA1c as i don't get tested at my doctors. Haven't been tested since my diagnosis of pre-diabetes a few years back.
So how on Earth are you going to assess what this program is achieving? No hb1ac before starting, few fbg , no after meal tests? Purely on weight?
Are you content getting readings consistently in the teens when you do test? it would terrify me.
 
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