Episteme

Mike's random thoughts and ramblings

Putting Type II Diabetes in Remission

Thursday, June 30, 2011 - We finished up the meeting with the client and decided to do a short debrief at Starbucks. While everyone else just grabbed a table, I walked to the counter and ordered two apple fritters and my usual iced tea. I ignored the strange looks from my colleagues while we recapped the meeting and I savored the sweet chewiness.

The meeting ended and I walked straight to the Morton's in the hotel lobby. I ordered a half dozen oysters, a Caesar salad, a cowboy ribeye and creamed spinach. Oh, and a martini and two glasses of good red wine. And on the way back to my room, I had a Snickers bar

What had inspired this Dionysian display of gluttony? It was like I was eating my last meal for 8 weeks.

I was.

The Lim Protocol

Two weeks prior to my Mortons experience, a friend had posted a link to a rather inflammatory study on her Facebook: "Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol". It seemed like pseudo-science - I've seen more than a few ridiculous claims about people finding ways to control T2DM, including a total no-carb diet (Bernstein) and total vegan diet (Barnard). But the idea that you could cure it with diet made it sound like the kind of thing Kevin Trudeau would write a book about.

For those that don't know, I was diagnosed with T2DM last year when I had my appendix out. It wasn't a total surprise based on family history - my Uncle Steve is diabetic, and we both share the same body shape and physical characteristics. What was a surprise was how out of control it was - my A1C was over 11 and my blood sugar was in the 400 range. I awoke from surgery to my short, rather old, Indian surgeon (imagine an Indian version of Yoda) yelling at me through the anaesthetic haze about how I was likely to die.

The doctors prescribed heavy doses of the standard meds: Januvia, Actos and Metformin. But I've always been rather unimpressed with the meds - they really didn't seem to do much other than keep my blood sugar in a barely tolerable range and most of the literature seemed to indicate a long-term progression to more meds and progressive symptoms over the long term.

And I have been unwilling to accept that as a fate. I regularly read the medical journals about the newest advances in understanding of T2DM, and the Lim study actually wasn't some quackery - it seemed to follow sanely on the ideas that other research has been discovering about the role of intracellular lipds as the cause of T2DM.

The basic synopsis of the basis Lim study is thus: Lipids (fats) in the system get in the way of insulin regulation in the body, causing the symptoms that we call diabetes. If we could radically reduce the lipids in key systems (e.g. the pancreas), we would see a return to normal metabolism. When looking at diabetics who undergo severe caloric restriction due to bariatric surgery, this is exactly what happens - after a very short time period (too short to cause significant weight loss), these patients have significantly increased insulin function and in short order reverse diabetes. The study that Lim and his colleagues performed in Britain took "normal" newly diagnosed diabetics and attempted to replicate the same results with one trick - they did it without the bariatric surgery by creating a severe caloric restriction (600 calories / day) for 8 weeks. And the results were, as the press release said, remarkable: all members of the study completely reversed their diabetes after 8 weeks.

If this truly worked, I knew then that I had to try it. Which meant eating 600 calories daily for 8 weeks.

"A Perfect Candidate"

After figuring out exactly what the protocol was, I turned to a friend who is an award-winning dietician and asked her for her opinion on doing something this crazy. She gave me tons of advice and approved of my choices of food, and also mentioned that she thought that I was "the perfect candidate" for doing something like this.

I took that to mean: "Mike, you're just insane enough to pull this off."

There was only one major stumbling block: it was the end of June, and I was scheduled to race the Ironman 70.3 World Championships on September 11. So I had to do this while training for a fast half-ironman triathlon in the summer heat of Las Vegas. Even I though that might be a bit excessive. But it was worth the risk to potentially cure my diabetes.

So, on June 30, I had my "last meal" and my last doses of medication and dove in. That gave me 10 weeks until the race, which meant I'd be eating again for two weeks once I actually had to race all out.

The Protocol

600 calories is a startlingly small amount of food, especially when attempting to get a full nutrient profile. Sure, one could eat a single Big Mac per day and only eat 600 calories, but the nutritional value of that diet leaves something to be desired. The original Lim study was sponsored by Nestle and used a special product that Nestle uses for those who have had bariatric surgery as a meal replacement - the study participants "ate" about 450 calories of this liquid meal replacement per day, and around 150 calories of green/leafy vegetables (e.g. Spinach, broccoli, cauliflower, lettuce, etc.)

This wasn't going to work for me, as I couldn't be using a product that I had to order - during the 8 weeks, I was to spend about 25 nights on the road. I couldn't be carrying a suitcase full of special meal replacement drinks around the country and on client sites.

So, having consulted a few people who would know (including the aforementioned dietician), I settled on Muscle Milk Light as the meal replacement of choice - it's available at almost any corner store or gas station (and in many airports) and I could have the powdered version at home (and carry some as a backup). Three bottles of Muscle Milk Light from the corner store ends up at about 510 calories.

That, I supplemented (as in the original study) with green vegetables. Salads with only vinegar (not vinaigrette because oil is full of calories) and oregano from Subway. Steamed spinach and broccoli from room service. Etc.

As for training, I continued to build my training volume as before but cut out all intensity - I went with a training program that looked a lot like something out of a book by Dr Phil Maffetone. I set my heart rate monitor based on the 180 formula so that my max on any workout was 135 and built my long ride to 4 hours and long run up to 3 hours at the end of the experiment.

Beginnings

I was barely back in my hotel room stuffed with steak before the dread (and the indigestion) set in. What was I getting myself in to? I started to question my own sanity and had to talk myself out of quitting the whole idea before I even started. Had I known then what I was in for, I'd have started the next morning with steak and eggs.

Instead, I awoke on the first of July and drank the Muscle Milk Light that I had purchased the previous night at the drug store, sent an email to a couple of friends wishing them a happy Canada Day and went to the client's office. A few hours later, I had the second MML and I was feeling great.

"This isn't going to be that hard", I thought around 2pm.

Around 3pm, I head off to the airport for my flight home.

I had a connection through Atlanta on my way home to Las Vegas. By the time we landed in Atlanta, I was in a full-on physical panic. My body was screaming for food, and I was nearly frantic as I searched the stores in the terminal for one that had Muscle Milk. I did three full terminals before finding one (in the international terminal, in case you were wondering).

The little smoothie bar was closing as I walked up - it was 9:02pm and they closed at 9. But the woman let me buy the drink anyway - I have a feeling that it was facial expression that somehow combined the pleading of a six-year-old with the intensity of someone who was likely to do something rash if she refused. That Muscle Milk calmed me down until about half-way through the flight. This was not going to be easy. My body was in full-on revolt and this was only the first day.

That was pretty representative of the feelings of the first few days - my body reacted badly and with a large variety of strange reactions. I would go from calm to heart palpitations instantly. Too cold. too hot. And a constant irritability - I felt consistently uncomfortable in my own skin. The fourth day, I was sitting in the terminal at LAS awaiting another flight and suddenly I started sweating buckets. For about 15 minutes, I sweat non-stop, so hard that my shirt was soaked through. And then the sweating stopped as suddenly as it began.

My wife Melina quipped that she didn't know I was menopausal.

In short, I was going through withdrawal symptoms. From food. I was a 3-meal/day addict for my entire life, and I was quitting somewhat cold-turkey.

The worst were the dizzy spells. While my dietician friend had warned me that I'd have dizzy spells in the first few days, they never really went away - they were certainly worst in the first week (when I was dizzy almost any time I was upright) but they continued even in to the final week of the experiment.

And it worked.

The Sixth Day Inflection Point

For me, the key to the experiment was the first week. Lim had reported a major change in morning blood sugar values at the end of week 1 for study participants - in my mind, I had set that point as an important checkpoint for myself. If I hadn't seen similar progress at the same point, I doubt I could have continued.

In fact, after 5 days (as you can see in the graph below), there had been almost no change and I was getting rather discouraged and frustrated because of the physical symptoms and lack of progress. But I woke up on day six and everything changed. My blood sugar normalized in a range that I hadn't seen in almost a year of daily monitoring - after six days, the graph had changed radically and my sugar stayed in a similar range (with daily fluctuations) for the duration of the experiment. In short, my results started to look exactly like those of the study participants.

But even though it was working, it was hard. After the first few days of physiological withdrawal symptoms, I largely got used to the program and things started to settle down. It was then that my brain took over.

Fighting My Own Mind

I often talk about evolutionary psychology when I speak about the human condition (especially in my talks on social engineering). Never in my life have I been so in touch with the most primitive parts of myself as during the 8 weeks that I went on this diet. As Maslow pointed out, our drive to satisfy the physical needs is at the very base of our psychological need structure, and I was depriving myself of that on a daily basis.

The changes in my psychology were stark and noticeable for me. Beyond the general irritability, i was consistently aware of little changes. In normal days, my sense of smell is almost non-existent. It's almost a running joke with my wife how little I smell things in my normal life. But within 2 days of the beginning of the experiment, my sense of smell was heightened to a level I didn't know possible. I could smell food if it was within 200 yards. And with that, everything else - I was noticing flowers, perfume, and nearly every smell around me where I never did before.

More interesting from a limbic system perspective was the strange confusion that I often felt at a preverbal level. This is much more difficult to explain in words, but if I was around food (especially if I could smell it), I could feel a strange sensation that I can only equate to the feeling of my body saying something to the effect of:

"Hey Moron!! You're starving and there's food RIGHT THERE. Why aren't we having any of it???".

This feeling presented as a low-level anxiety that I previously wouldn't have been sensitive enough to be aware of.

That brings me to the most important mental awareness - how often I used food for something other than the basic need of nutrition. When I couldn't eat, I suddenly became aware of the other things I've always used food and meals for - connection with others, something to do when bored, and an escape when stressed. When I couldn't use food in those ways, I suddenly became much more intensely aware of the sensations within my body at a given moment.

This gave me a much more well-developed sense of what I wanted at a given moment - because I couldn't escape from the constant awareness of my own body and the low level physical arousal of anxiety from not getting my needs met, I found a much lower tolerance for the little irritants of life that I might have previously ignored or managed to distract myself from. As a friend said to me mid-experiment:

"I liked you better when you were eating."

In short, I spent 8 weeks feeling quite insane. And, in many ways, much more sane than I have ever been. The entire experiment was the hardest thing I have ever experienced - in 8 weeks, there was never a day that I could call "easy". Luckily, the original study results set enough data points that I was able to mark my own progress to those of the original participants.

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Michael Murray

Michael Murray