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.

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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Getting Back on the Horse

I've been reluctant to write this post for several months. This blog has been untouched for over a year, during which I lapsed. Now, I weigh at least 10-15 pounds more than my former maximum weight. It's horrible and it's my fault. (More here if you want to know my personal background.)

Look at the success stories of people on the paleo/primal/evolutionary/whole food diets, especially those doing Intermittent Fasting (IF). They are strong evidence of what works.

My success doing that diet, and then my failures not doing that diet are also strong evidence of its effectiveness.

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Here are the mistakes I made:

1. Skipping my workouts, from a few less workouts to none in a matter of a couple weeks. That is crucial because exercise helped tremendously to keep me feeling good, full of energy, and less hungry.


2. Stopping Intermittent Fasting (IF), since workouts go along with that.


3. Not cooking for myself for all my meals. Sometimes had one or two healthy meals, but started substituting fast food (at first, throwing out the buns on a hamburger, the tortillas for tacos, and such.) Fell into old patterns of just eating fast food as is--maybe not for every meal, all the time, but enough to sabotage the meals that were healthier.


4. Indulging in junk food snacks for dessert or late-night snack. Big Mistake! Ice cream was my Achilles Heel. Cookies, candy, pastries came soon after. Said screw it, thinking I could give them up any time and go back to sensible eating. (Sounds like an alcoholic or drug addict, huh?)


5. Fell prey to addiction to junk food. Willpower became less effective, which was maddening. Had stupid pity parties, wallowed in guilt, and tried (ridiculously) to eat my way out of stress. It's a vicious cycle, in which my stupid choices kept making it harder to escape.

The short version: I stopped being active and ate junk.

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Excuses excuses: My diet failure is my fault and only I can fix it. Sure, a few things were made worse by external stressors (job security in a time of big cutbacks where I work, frustrating, melodramatic tensions between us and our teenager, a few illnesses and a tonsillectomy). But most of it was directly or indirectly because of my poor choices. At least on a previous diet over a year before I tried paleo+IF, I had one good excuse: medicine I took for a few weeks (unbeknown to me) dramatically increased hunger and that didn't wear off after I stopped taking it. I don't have that excuse this time.

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Doing the paleo+IF thing made it much easier to deal with hunger and was actually enjoyable, rather than drudgery.

At this point, I could continue to feel guilty, self-destructive, gluttonous, and pitiful but no amount of excuse making will stop this. I've got to make a change now before it ruins my health (I've already got pre-hypertension).

I've been trying to eat paleo (or paleo-ish) meals the past few days, which could be the start of another round of losing multiple tens of pounds, getting below 200, and feeling physically and mentally better. The next step is to exercise, which is tough to start, but quickly beneficial to curb temptations. Now, this blog ought to be called My Diet 540°, to be more accurate.

I also plan to blog here to record how things are going. If you read this and don't see me posting, please feel free to send me e-mail to ediafono at the gmail dot com address. Any words of encouragement would be more appreciated that you can imagine.

Diet Yo-Yo

This post is mainly for my own benefit. You can skip it unless you're really curious. I'm tired of trying to do math in my head to figure out what years I did what sort of diet and exercise programs.

I have another article in which I try to analyze my diet successes and failures as a part of identifying lessons learned. I've taken the details out of the other article and put them here, which I hope makes the other post more interesting to readers:

Late 70s, early 80s

Jogging a mile or two several times a week. Included sprinting. Usual PE and playground activities at school. Cycling and exploring woods for fun.

1983

Started smoking. Would continue until 2004, though I did quit for months at a time.

Mid-Late 80s

Got lazier and lazier. Ate more and more. My friends and I would have contests to see who could eat the most pizza at a buffet.

Late 80s, early 90s

Cycled occasionally. Lifted weights occasionally. Played racquetball and softball. Too sparse to make much difference.

Early 90s

Ocassionally cycled on trails and steep inclines (upper Hudson valley). Joined weightlifting club for many months. Played racquetball occassionally. Only the weightlifting had an appreciable benefit.

Mid 90s

Drank, smoked more, ate more, did nearly no exercise.

Late 90s

Quit smoking for longer periods (used patches and gum). Joined gym and did aerobic machines and weightlifting machines. Played racquetball. Learned how to swim enough to do laps, so I could swim multiple times a week. Weightlifting, again, had most benefit. Swimming also helped quite a bit. I estimate I lost about 10-25 pounds, but I honestly don't remember the numbers now.

Early-Mid 00s

Smoked, drank, got very little exercise. Ballooned in weight and struggled to do basic activities. Tried Atkins for a couple weeks, but had trouble dealing with hunger.

2003-2004

Struggled with quitting smoking. Succeeded in Mar 2004. Increased hunger, unfortunately.

Feb 2006-Jul 2006

Lost almost 50 lbs. Walked miles most every day. Reduced caloric intake. Avoided sweets and other junk snacks (mostly). Tried (ignorantly) to limit fat. Fasted for short periods of time and felt a bit of a "high" from the ketosis, in a good way.

Aug 2006-Sep 2008

Medicine I took for a few weeks made me super hungry (which I didn't realize until later). Threw me off track. Walked only occasionally, ate more and more junk food. Gained back weight.

Sep 2008-Mar 2009

Paleo/evolutionary/whole food diet with Intermittent Fasting (IF). Lost 45 pounds and felt wonderful. Did not struggle with hunger as with other diets. Felt alive.

Mar 2009-Mar 2010

Tapered off diet. Gained back the 45 pounds, plus 10-15 more. Occasionally tried to restart paleo diet, but resumed no-exercise, unhealthy food lifestyle each time.

Mar 2010-early 2011

Restarted paleo/IF diet again. Lost about 45 pounds again.

early 2011-Apr 2012

Tapered off diet, gained back the weight.

Apr 2012-May 2014

Had several bouts of illness.  Was bedridden a number of time for up to several weeks. Lack of exercise resulted in more weight and loss of stamina.  In Feb 2014, blood tests indicated prediabetes.  Dieted inconsistently.  Lost perhaps five pounds.

Jun 2014

Focused on diet and lost additional 15 pounds.  Mid-month, hemoglobin A1c was in type 2 diabetes range.  Put on medication. Took it for a day and a half, then decided to stop until I could consult doctor about side effects.

Continued with primal diet (with dairy), strictly cutting out gluten. Skip meals occasionally. Portion sizes are getting smaller and I am dealing with hunger much better. Have lost about 25 pounds by the end of the month.

Introduction

I'm a 39-year-old man tired of being overweight, with all of the discomfort and health problems that entails. I am pursuing a nutrition plan inspired by others who describe their diets as "Evolutionary" and "Paleo". Broadly, this means that, as much as possible, I am eating whole foods, without any grains, processed food, or "diet" drinks. I am including intermittent fasting, and my exercise workouts are designed to build muscle mass.

Richard Nikoley's Free the Animal website has been my primary source and inspiration. I've been reading him for years, before he got into fitness. I was a little put off at first that his political and social commentaries were on the wane, but after seeing his results and knowing I needed to change my ways to be healthy, I decided to follow his example. Initial results are promising. Unlike past diets, where I relied on willpower to deal with limiting calories, now I allow myself to eat as much as I feel like, but only whole foods. I was able to lose 45 lbs. in 2006, which required a lot of willpower. I eventually fell into old habits and slowly gained it all back, but I expect that I won't have to struggle as much, if I have the option to "binge" on healthy foods.

I will probably not be updating this website on a timely basis. I expect to have occasional flurries of recipes and food pics, results, and the like.