Metformin and Fasting

One of the penalties for indulging in junk food and not exercising, besides obesity, is metabolic problems, like (pre)diabetes.  As I've confessed in previous blog entries, I haven't been taking dieting seriously, and now I've crossed into the (pre)diabetes zone.

Currently, I'm faced with the dilemma of whether or not to take the medication prescribed to me for glucose intolerance.  I tried it for a day and a half, had some strange symptoms (pain in my right side, feeling very fatigued), and decided to stop taking it.  My doctor wants me to take the medicine for a couple months and then test my blood levels again, at which point he'll decide if I've done well enough in my diet to be able to cut the dose in half, or if, according to his attitude, a miracle occurs and I don't need to take it anymore.

One option is to skip the pills and go balls to the wall on eating clean, exercising, and fasting to shed my weight and naturally get my metabolism back in the healthy zone.

The other option is to take the medication while doing the same.  I'm not sure how to manage intermittent fasting (IF) with the medicine.  A google search pops up all sorts of opinions, typically the scaredy cat admonition that diabetics must never skip meals and probably should be eating at least a few bites every 20 minutes.  A few people not terrified of IF offer different advice: take the pill, skip the pill.  But I haven't seen any solid information, either from someone who was taking the medication while doing the primal/paleo thing with IF, or from someone with more than a few half-informed notions of what's what.

If I send a message to my doctor's nurse, I'll get an answer in anywhere between 4 hours and 2 weeks.  Asking him, or the nurse, about whether to take the pills when I fast, there is a good chance he or she will say that skipping meals is baaaaad and not be helpful one bit.

OK, for the nitty-gritty:

Lab Results

Feb 13, 2014:

weight	(lbs.)	~240	(165-175 is my goal)
fasting blood glucose	(mg/dL)	122	(70-105 is normal)
cholesterol	(mg/dL)	197	(≤ 200 is "good" *)
HDL	(mg/dL)	43	(40-59 is "OK", ≥ 60 is "good" *)
LDL-calculated	(mg/dL)	139	(≤ 100 is "optimal" *, 100-129 is "OK" *, 130-159 is "borderline high" *)
triglycerides	(mg/dL)	76	(≤ 150 is "normal" *)

Jun 12, 2014:

weight	(lbs.)	~222	(165-175 is my goal)
fasting blood glucose	(mg/dL)	86	(70-105 is normal)
hemoglobin A1c	(DCCT %)	7.0	(4.0-6.0 is optimal for non-diabetic, ≥ 6.5 is a criterion for the diagnosis of diabetes)

* Some of the comments on the evaluation of given ranges are surrounded by scare quotes, due to the common wisdom of medical providers having a tendency towards being wrong, particularly on the subject of lipids.

The A1c glycated hemoglobin is a marker they use to estimate the average blood glucose level over the previous three months.  I've searched for the meaning of the number and gotten a variety of different interpretations for a 7.0%.  According to Wikipedia, that indicates a mean glucose level (mg/dL) of 154±31 (123-185).  My doctor said the cutoff for diabetes type 2 is 6.5%, but then he wrote on my chart a diagnosis of ICD-9 277.7, which is commonly called "prediabetes", but more formally called "metabolic syndrome X" or "insulin resistance syndrome".  So, I'm not sure if he thinks I am actually diabetic, or just flirting with it.

Prescription

Glucophage (Metformin) 500 mg pill, twice a day with meals.

I took it three times, starting in the evening of my doctor visit.  I admit I was shaken up by his words and his attitude, and worried that if I didn't take the medicine, all sorts of damage would be continuing to wreak permanent havoc.  But when I did take it, I developed a pain on my right side, below the ribcage.  It wasn't the liver or kidney area, so I'm thinking it was general intestinal distress.  I mentioned the dosage to someone who currently takes it and she was shocked that the doctor didn't start me off slowly, taking one pill every other day and working up to the twice a day level, to avoid the intestinal problems.  I also felt very fatigued, which I'm guessing was the medication artificially dropping my glucose.

So, if you have taken Metformin and fasted intermittently (whether it was just skipping a meal or a full 24-36 hour fast), I would appreciate any insight you might have on whether to take the pill during a fast.  Or, if you have expertise on the subject and can provide me with explanations for why I should or shouldn't take the pill, your advice will be welcome.  Otherwise, I'm not looking for guesses or notions.  Only experience or expertise are of interest to me.

Thank you.

Paleo/primal success and failure

Since February 2006, I successfully lost 45 pounds or more three times. Except for the first time, I lost the weight using paleo/primal eating habits. The second time, I used intermittent fasting (IF) twice a week, for 18-36 hours, depending upon how long I could hold out. I exercised towards the end of the fast to maximize fat burning. My workouts were about 20 minutes of interval strength training. The third time, I lost the weight mostly by diet, without a serious exercise program.
The first time, I lost 50 pounds via diet and exercise (mostly walking). Between 1994 and 1999, I had done a lot of weight lifting and swimming. I was under 200 lbs. at the time, and added quite a bit of muscle, so weight loss was not much of a concern to me at the time. The whole diet yo-yo has frustrated me, but I keep trying to reset and try to achieve lasting success.
The reasons for failure: fast food, ice cream, and lack of exercise. The mindset that I'll eventually get around to losing my weight again, just not today, is a denial of reality which can only go on for so long. As Ayn Rand said, "You can avoid reality, but you cannot avoid the consequences of avoiding reality."
Now, the consequence is that I'm facing type 2 diabetes, so the stakes have been significantly raised. I've seen quite a number of success stories of people using a paleo/primal diet and exercise approach, who were able to reverse diabetes and return to normal levels. I prefer to do that than to depend on medication in the long term.

Updated the first couple of paragraphs to more clearly describe previous successes.

Ribs, Jack Daniel's Sauce, and Coleslaw

Last night, I tried Richard Nikoley's technique for cooking baby back ribs. Instead of The Salt Lick dry rub (which is reportedly hot), my wife put on Emeril's Essence and some Italian seasonings. They turned out wonderful, but they were falling apart when I took them out of the oven. We cooked them for 4:15, which was much too long. I didn't get to cook them on the grill the way Richard did. Instead, I put foil on my charcoal grill, and put the motley assemblage of parts on the foil. Not ideal, but they did get some smoky flavor (mesquite infused charcoal briquettes). Next time, I'll take them out of the oven after 3 hours or so.

I wanted to try the Son of Grok's BBQ sauce, but my wife was anxious to try a recipe for Jack Daniel's BBQ sauce. She substituted some organic natural cane sugar for the brown sugar. She only had 1 1/4 cups of ketchup left, so she added in some tomato sauce. She used 3/4 cup whiskey. I can't recall ever having a better BBQ sauce. Still, it's way too much sugar to be healthy.

For sides, she baked some frozen sweet potato fries (a handful for each of us), and made a coleslaw. Her recipe for the coleslaw was a modification of a cranberry coleslaw from a cook book:

Ingredients

• 1/4 cup mayonnaise dressing
• 1 tablespoon red wine vinegar
• 1 heaping tablespoon honey
• 1 cup red seedless grapes, halved
• 5 cups coleslaw mix with carrots

Directions

1. For dressing, in a small bowl, stir together mayonnaise, honey and vinegar. Stir in grapes.
2. In a large bowl pour dressing over cabbage; toss to combine. Cover and chill up to 45 minutes.

It was a wonderful meal, despite the difficulties with the ribs being too soft.

My dogs loved licking the foil clean and munching on the cartilage.

Lilly: Paleo Dog

Our youngest and smallest mutt, Lilly, is a toy Dachshund mix. At 2 years old, she's about 6" 9" at the shoulders and 14 lbs.. When we got her at 6 weeks, she had typical Dachshund ears, hanging straight down.
A few weeks later...BOING! Her father's breed is unknown, but clearly he passed on those ridiculous ears to her. We suspect it's a Corgi trait.

As a pup, Lilly was ferocious and nearly unmanageable. Luckily, as she's matured, she's become more well-behaved, with a typically sweet, affectionate Dachshund personality. She simply waddles up to people, collapses against them to expose her stomach, and looks up plaintively in anticipation of a tummy scratch—which she almost always gets.

She loves to play fight with our other dogs, Sandy and Moxie. Sandy is a Chihuahua mix, much taller than Lilly, but lighter and less muscular. She tries to play the alpha bitch role with Lilly, which only works part of the time. Sandy's aggression works until there's food, and then Lilly's stout body works to her advantage—she just stands there and eats as she pleases, no matter how much Sandy tries to intimidate her. When it comes to playing tug-o-war, only Moxie, our Lab-Dalmatian mix, can keep up with Lilly. He's five or six times her size and gentle enough not to hurt her.

All three dogs have worked as a pack to catch and eat critters in the back yard. A dozen or more times, they've come in reeking of a dead animal, probably when they roll around on it. (Guess who gets to bathe them?) We've found parts of a baby opossum and a large rat. I found a rodent's nest on the back porch after I saw the little ones hunting in that area. But what makes Lilly my little Paleo Dog is her penchant for grub worms. My yard looks like I have gophers because she digs holes all over the place to get to her succulent treat.

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Seeking Advice

I'm seeking advice on getting a loved one into the Paleo lifestyle. After seeing my experiences with and without using a evolutionary fitness approach (Paleo food, Intermittent Fasting(IF), plus strength and sprint exercises in fasted state), as well as seeing some inspirational videos like this and this, she has decided she wants to try it. She would like to lose several tens of pounds she has gained in the last decade or so. She was extremely thin up into her 30s.

However, she has a number of health problems, most of which predated her weight gain by several years. I'm looking for advice from people who have any first-hand experience or informed advice about the kinds of exercises she could try, and what to avoid. While we would appreciate words of encouragement from anyone, if you don't have training or specific relevant experience with these problems, please refrain from guessing what might work. Having done the paleo diet, IF, and resistance training exercise, I have plenty of advice myself, but I know that she can't do many of the things I do or the types of exercises I've found in articles and videos in the Paleosphere.

She does plan to consult with a physician, but (1) most doctors' advice is either too little or just flat wrong (e.g., SAD diet with low-fat, "heart-healthy" whole grains) and (2) it always helps to have options or a plan to present to the doctor when you walk in, rather than making an open-ended request.

I realize that many health problems can be related to poor diet, sedentary lifestyle, smoking, stress, and other factors we can control. It's obvious to us what negatives to avoid. Many years ago, she used a Callanetics workout tape (VHS). She has also done a program of walking several times a week. These did help, but we're looking for additional options which may be more effective (or a good addition to walking, for example). Some things we've considered: aquatic aerobic classes (reduced strain) and a moderate circuit training program (like Curves). But these may be too difficult or not very effective.

Her health problems must be considered. She has:

• mitral valve prolapse, for which she takes heart medicine (when she was first diagnosed >15 years ago, the doctor warned her not to do intense exercises like a stair master as that would be too much of a strain on her heart. Currently, she has problems with dizziness when she stands up, which seems to be heart related. After about a minute, the dizziness fades, though. Doctors haven't been all that helpful, beyond prescribing the medicine to treat the MVP.
  
• back problems, including C-shaped scoliosis and chronic back and neck pain. Much of this may be a result of a car accident when she was about 20.
• non-diabetic peripheral neuropathy, optic neuritis, and some other nerve problems which neurologists have been unable to figure out.
• plantar fasciitis, which was so bad several years ago she had to walk with a cane. Doctors treated it by taping up her feet for months, which solved the problem at the time. She still has occasional problems with it though, and it may need to be treated again if it gets worse. (Wearing a foot brace at night and rolling the foot over a can does help.)
• constant muscle pain in her arms and legs. Doctors have diagnosed her with fibromyalgia and chronic fatigue syndrome. I realize these diagnoses are controversial for some, but rather than debating them, just bear in mind that she will need extra time to recover from exercising.
• asthma, for which she takes medication (but has not needed to use an inhaler but a few times several years ago).
• ex-smoker (quit 6 years ago).
  

If anyone has any helpful hints, thank you in advance.

Three Weeks

A little more than three weeks in and I still feel much better than before I resumed the Paleo fitness program. I hit a plateau this week as I lapsed in the fasting and exercise schedule, ate too many calories (nervous eating when I wasn't actually hungry), and perhaps ate too much fruit.

Exercise: I had planned to get more exercise doing yard work. However, we got some rain and I kept telling myself I'd do the work the next day. Things still haven't dried out, so I decided to get off my lazy butt and do a workout inside. I didn't fast until yesterday, when I skipped lunch. After that I used my son's new exercise equipment, a Gold's Gym short series resistance tube kit. (Here is the long series one, which is similar.) I got about 25 minutes into the DVD. Once I hit the squat thrust section, I called it a day. Yeah, I got wimpy not exercising for a year. The good thing is that I have almost no soreness today. I'll have to step it up next time.

I also have an Iron Gym workout bar that fits in the door frame for pull-ups, a couple kettle bells (4kg and 8kg), a lunge bar, and a big Labrador Retriever who loves to play tug-of-war, for working out at home.

Fasting: I only fasted once the past week, and only skipping one meal. Sometimes it's hard to synchronize meal planning with the family, grocery shopping, and fasting. I hate wasting good food by letting leftovers or uncooked food stay in the refrigerator too long*. I'm going to have to apply some scheduling and planning discipline to get back into the rhythm.

Food: I'm about 95% sticking to the Lacto-Paleo set of foods. However, the amount I'm eating is too much and unbalanced (too much fruit, which I eat to satisfy cravings for sweets).

Cheats: I tried hummus for the first time. Twice I ate it on crackers. I had a little bleu cheese dressing which was mostly soybean oil. Maybe a few small squares of chocolate. Not too bad.

Weight: I dipped down about 4-5 pounds since last week, but immediately went back up. After fasting and exercising yesterday, I went back down this morning. But I'm going to have to push harder (cut back on calories, fast and exercise more often) to speed up the weight loss.

Sleep: This is a problem for me that I think I've been overlooking. I often get less than six hours a night, which I've read may hinder weight loss and fitness.

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* I've learned the hard way not to take chances with leftovers. With the exception of a few things like cured bacon, I throw away anything I cooked more than three days prior—cooked eggs at most two days. I more readily toss out jars and cans past their expiration date. I once got violently ill from some sauerkraut because some of the cabbage was above the top of the liquid for days or weeks, giving it time to grow something nasty.

Furniture Slider Ab Workout

From RossTraining.com: