“What if we’re wrong about diabetes?”

That’s the title of this video, which came up in Lisa’s YouTube related videos feed about a year ago.

It’s a gripping TEDMED talk from 2013 by Dr. Peter Attia, who confesses the judgmental attitude he had harbored six years earlier toward an obese patient who had come into the emergency department with foot ulcerations.

She obviously must have let herself go, he thought, consuming too many calories and not moving enough.

But then three years later he found himself 40 lbs. overweight and with metabolic syndrome, and he knew that physical inactivity was not the cause in his case: he had been “exercising three to four hours every day, and following the food pyramid to the letter.”

It led him to wonder whether, in the case of obesity, insulin resistance and type 2 diabetes, the medical community might have the chain of causation backwards.

Watch this video. It’s totally worth the 16 minutes.

I have found Dr. Attia one of the most thoughtful online voices when it comes to evaluating and making sense of dietary and lifestyle research related to both longevity and healthspan.

As he says in this video, perhaps he’s been humbled by what the thought he knew that turned out to be mistaken.

I expect I will have several more posts in this series that feature (or at least mention) Dr. Attia. His website is an amazing resource, and his podcast, The Drive, is the only one for which I pay for premium access.

Like Tim Ferriss, Dr. Attia also has introduced me to many other leading researchers and thoughtful analysts. Follow him on Twitter.

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An Unfortunately Named Book

The Obesity Code by Dr. Jason Fung came up among my recommended titles on Audible in May of 2018.

The name didn’t put me off, because the subtitle was compelling: “Unlocking the secrets of weight loss.”

And while by that time I had lost about 25 lbs. through the Trim Healthy Mama Plan and the Slow-Carb Diet, I figured this highly rated and recommended book would add to my knowledge.

Little did I know it would be among the most important books in my health journey.

Dr. Jason Fung is a nephrologist who became increasingly dissatisfied with his practice because he felt helpless to deal with the progressive kidney damage his patients were experiencing.

Many if not most of them had diabetes resulting from obesity, which led them to need increasing amounts of insulin, which led them to gain more weight, and the cycle would continue. Eventually, they would end up on dialysis or would have foot ulcers that required amputation.

In listening to this book, I felt an increasing sense of the despair he must have felt in his practice, because in the first several chapters he laid out the scope of the problem, describing both the epidemic of obesity and why so many diets fail.

Essentially our weight control mechanisms behave like a ratchet, at least in our current food environment. Once we gain weight and our bodies adapt to a new normal, they in effect establish a new “set point.”

If we then follow the “eat less, move more” advice as exemplified by The Biggest Loser, we may achieve some short-term success, but at a long-term price. With chronic caloric reduction, our metabolisms slow because our bodies sense starvation and the need to conserve energy.

Instead of a basal metabolic rate of, for example, 2,000 calories per day it may be reduced to 1,500.

Our body temperature is reduced, as is the stroke volume of our hearts. We end up cold, tired and hungry.

Then when we resume normal eating, we gain it all back (and more) because we still have the lowered metabolism.

Fung describes obesity as primarily a hormonal issue, and highlights those hormones that play the largest roles: leptin, grellin, cortisol and, above all, insulin.

He describes how the Atkins diet showed some success, but that it too tends to have problems with long-term compliance.

This dreary story continues for 18 chapters, until he summarizes as follows:

There are two primary findings from all of the dietary studies done over the years. First: All diets work. Second: All diets fail.

Dr. Fung then gives some helpful advice on the importance of eating whole foods and avoiding sugar and refined carbohydrates. But it isn’t until the final chapter, after nine hours of describing the futility of other approaches, that he provides the solution.

As I said, the title of this book is really unfortunate. I would love to have all of my friends read it, but the title makes it kind of awkward to recommend.

Five days after I downloaded The Obesity Code, I bought a book coauthored by Dr. Fung called The Complete Guide to Fasting, which helped me to understand and implement the solution advocated in Chapter 20 of the first book.

I unreservedly recommend both, but if you want an introduction to Dr. Fung’s message, this address from last year will be helpful.

Next time I’ll tell you what happened when Lisa and I implemented a fasting regimen for 10 weeks starting in mid-May 2018.

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Cadaverous to Corpulent

In the Spring of 2008, I had some amazing things happening in my life, both personally and professionally:

  • I learned that our first grandchild (coming in August) was going to be a girl, and that her name would be Evelyn.
  • We were launching several of our early Mayo Clinic social media channels, including YouTube, Twitter and some blogs (News and Podcast) that have since been replaced by more robust offerings.
  • I was blogging like a crazy man, with 33 posts in April, 17 in May and 24 in June. This was peak SMUG, just after I had rebranded my blog.

But from a health perspective, I was at the start of some disturbing developments.

For several years, I had been giving blood every 10 weeks (or whatever the required waiting period was at that time.) When I went to the Mayo Clinic Blood Donor Center to give my unit of A+ blood (only the best!), the helpful staff would always help me preschedule the next donation.

But in the Summer of 2008, I began to notice that my pre-donation hemoglobin test, which started with a reading of something like 16, was declining a little each time.

I didn’t think much of it when it was 15, and then 14-something, but then it got to 13…and finally, in January 2009, to 12.4.

The magic of that number and why it’s memorable to me is that 12.5 is the minimum level required to donate.

I was officially anemic. They wouldn’t accept my blood.

I thought I should see if there was some underlying problem. Lisa also said she thought I wasn’t looking healthy.

I was at about 225 lbs. and playing pick-up basketball, and so I had attributed my reasonable weight (at 6’6″) as due to getting lots of exercise.

Lisa thought I was gaunt – skinny in a not-healthy way. Haggard. Cadaverous might be overstating, but it made an alliterative headline. And when you look at all of the synonyms, one of them is anemic:

So I went to my doctor, a high school classmate and great friend, Dr. David Strobel, and he started by looking for the most common causes of anemia for someone my age: namely, unexplained blood loss.

Thankfully, I didn’t have colon cancer or a bleeding ulcer. On March 13, 2009, he diagnosed celiac disease.

I recently wrote a post on the Mayo Clinic Social Media Network site about that celiac disease journey that highlights how social media helped me to cope: to learn about gluten free eating and where to find gluten-free restaurants.

The story I didn’t tell in that post was what gluten-free eating to manage my celiac disease did to my weight.

Because I have celiac disease, eating gluten had caused my immune system to attack and severely damage the villi in my small intestine, which made it hard for my body to absorb nutrients.

I was anemic because I wasn’t absorbing iron. I was gaunt because I wasn’t absorbing other nutrients well either, even though I was eating a lot.

The good news is most people with celiac disease have their villi restored when they eat a strictly gluten free diet, and that was true for me as well.

My iron and ferritin (a measure of stored iron) levels gradually increased.

So did my weight, and not necessarily in a good way. I was eating as I always had, but now I was absorbing all of those nutrients.

By March of 2013, my medical chart says I weighed 117.7 kg, which translates to 259.48 lbs. Two years later I was 117 kg – staying below the dreaded 260 lbs. mark, but just barely. In February 2016 the charts say 117.9 kg.

That’s also when I did the #ScopeScope.

My chart says my blood pressure in the pre-colonoscopy physical was 155/94, but later that year I was “only” 139/92.

The highest I remember reaching when I would weigh before workouts at the local YMCA was 265. But here’s the highest photographic evidence I have, from May 21, 2016:

So my Body Mass Index (BMI) on that date was 30.3.

I was officially classified as obese.

I understand the limitations of BMI, and I never had a doctor tell me I was obese.

But going from haggard to hefty – to the tune of 40 extra pounds – between 2009 and 2013, and then spending four years within five pounds either side of 260, and with borderline or high blood pressure, was not a healthy development.

In my next post I’ll tell why this was so frustrating for me.

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