Summary for the impatient: In the 6 months since that last blood test I’ve been able to lower my A1c from 6.2 to 5.9. I'm still in the "danger zone", but at least I'm only 2% off normal instead of 3% off being full blown diabetic. Progress.
I changed what I ate, how I ate it, exercised like a demon (aerobically and anaerobically), and I took a Vitamin D supplement daily. I don’t know if one thing or a combination of any of them did it, but now my goal is to get it below 5.7 (the magical threshold to being labeled “Normal”). While I am excited to be at 5.9, I also realize that one blood test does not success make… but it is a positive step in the right direction.
My doc informed me in early October 2015 that I was officially "pre-diabetic" with an A1c reading of 6.2. At 6.5 I would be "diabetic" and my doc alluded to various things which didn’t sound attractive to me. Unfortunately, our health care system being what it is, it seems to not allow our primary care providers with the flexibility or the time to discuss the "what now" guidelines. My doc gave me her diagnosis, some very general guidelines, and I was basically left to figure it out.Notwithstanding, the prospect of being diabetic scared me enough that I took my condition seriously.
At the very top of this is the fact that I don't think that I fit the profile of a person who might be prone to diabetes. To begin with, there is no history of diabetes in my family. I'm 5'10, weigh in at around 159 lbs soaking wet, have very little body fat, I do not eat sweets and unhealthy food, and am very active. I don’t sit at a desk, I run anywhere from 20 to 30+ miles per week, I bike, I kayak, I do a lot of physical work…. You get the drift: there isn’t much grass growing under my feet. I just can’t see myself fitting into the profile of a diabetic – I could be all wrong, but that’s my illusion…
Immediately after my docs’ diagnosis I went into "pre-diabetic crisis mode". Without any guidance other than that carbs and sugars were bad, I cut out carbs almost entirely and developed an eagle eye for the sugar content in everything. I love ice cream - no more ice cream. I like my coffee strong and sweet - no more sugar. I concentrated on proteins, selected fruits and veggies, and any carbs that I ate had to be complex carbs. I avoided anything that was "processed", came in a bag, and read nutritional labels fanatically.
Immediately after starting this new food routine I lost weight (6 lbs, maybe more?) in 8 to 10 days. And I had no energy. I couldn't run a mile without slowing to a walk. But it all kind of made sense to me: no carbs, no glucose, no glycogen, no energy. In my old world, carbs were my best friend: carbs = glycogen = energy and endurance. I kept pushing my runs, assuming that my body would figure out where to get the necessary fuel to convert to glycogen in order to sustain a run, but was unable to find it or adapt to it. It was horrible and frustrating. As a result of all this I had to back out of a series of half marathons that I had hoped to run during the Florida winter running season. If I couldn't run 3 miles, I clearly was not going to make it through three 13.1 mile events. Bye-bye entry fees....In desperate need of help and full of frustration, I wandered into the offices of the resident nutritionist/dietitian at a nearby Publix supermarket and met Anastasia - and I cried for help. I am certain that Anastasia thought I was a nut case. I explained my predicament, lack of knowledge, my running goals, and so on, and in return she took me through her process of examining my food and fluid habits and activities performed. I explained my running goals and my frustrations in achieving them due to my urgent need to address the pre-diabetes diagnosis. After a couple of consults she came back with two key things: 1) I was not consuming anywhere close to enough calories and carbs to sustain my level of desired activity (duh on me), and 2) she taught me that I could eat carbs (preferably complex carbs) but that for every 18g of carbs that I ate, I had to also have 8g of a protein (more on this below). In other words combine carbs with proteins.
Meanwhile, I began to follow the dietary guidelines that Anastasia recommended – and it was pretty simple actually. Carbs are ok as long as I concentrate on complex carbs. For every 18g of carbs, I made sure to also eat at least 8g of protein. Stay away from pre-packaged and over-processed foods. Don’t eat junk food. For example, a meal might include whole wheat pasta or brown rice and almost any protein (beef, chicken, turkey, fish, etc…). I scrutinize labels of any packaged food (i.e. canned or jar foods) for the one’s that have the least amount of added sugars. If the label had ingredients that I couldn’t understand or pronounce I’d toss it and look for another. I found that in the morning anything works as breakfast, as long as I follow the 18g carb/8g protein rule, i.e. multi-grain or whole wheat toast with hard boiled eggs, cheese, turkey, or peanut butter, etc., works fine. If I ate out (which happens a lot), avoid the crap food, focus on the veggies, fresh fish, and simple entrée’s. No french fries!
And as would be expected, now that I was ingesting some measure of carbs and more calories, I was able to run again. So that sort of solved that problem, but I was still concerned about lowering my blood sugar. Anastasia assured me that as long as I stayed away from simple carbs, made sure that I balanced out the carbs with a protein, and kept my activity levels up, I would see my blood glucose levels and my A1c readings go down. I have to tell you that I was running on faith.
So, for those of you that don’t know and are curious, I’ll explain what the relationship is between carbs, proteins, and digestion. As a runner, you already understand the difference between a simple and a complex carb. Simple carbs convert to glucose much faster than complex carbs. It’s that simple. And for a guy like me, simple carbs will cause sugar spikes that my system does not manage very well. Complex carbs obviously also convert to glucose, but do so much slower. And here is where the protein part of the diet fits in. Proteins tend to slow down the entire digestive process, thereby delaying the introduction of any carbs into my intestinal system. Fats slow the process down even more so, which is one reason why peanut butter is a go-to bread topping. So by slowing down the digestive process, I’m smoothing out sugar spikes and (hopefully) allowing my system to process the glucose. [Side bar here: I’m still researching if it makes a difference if I take in the proteins first, at the same time, or after I eat the carbs…]Ok – one more piece of the puzzle: insulin. We’ve all heard of it. It is produced by our pancreas. Insulin is the magical hormone that we have to have in order to process and absorb the glucose in our bloodstream into something useful. If our bodies don’t do that, then bad things happen to other organs, so this is important. In my case, my system is a somewhat “insulin resistant”. In other words, my pancreas is producing insulin just fine; it's the rest of my system that is somewhat less than receptive about using the insulin the way it is is supposed to. Ok, that sucks… More so since apparently my use of statins may have helped bring that about. Wonderful.
But Anastasia gave me another little clue that was interesting: It turns out that low levels Vitamin D play a role in insulin resistance. My most recent Vitamin D level was tested two years ago and it came in at 32 ng/mL, and apparently it should range between 30 and 100 ng/mL, putting me at the low end of the scale. I kind of thought that was odd since I spend a lot of time outside, but I’ve learned that the copious amounts of sunblock that I put on to ward off sun damage can limit the amount of Vitamin D absorbed. Interesting stuff. And so, you guessed it, I started taking a Vitamin D supplement. My doc doesn't put too much credence on the Vitamin D effect, and referred to new studies that put the normal range to somewhere between 20 and 50 ng/mL. Food for thought... I'm going to stay on it through to my next blood test though.
By figuring out what I could eat and how to combine it all together (carbs and proteins), I was able to train up for the last Half Marathon of the FL season (at least one that was near me). I was coming from behind with regards to my endurance training and was simply hoping to cross the finish line vertical and preferably running. As it turns out that event was a Personal Best for me, finishing a full minute faster than my previously best HM. I ran hard and as strong as I dared. But I should also note that it helped that the course was pancake flat and the temperature was in the perfect low 50’s! This was the first time that I’ve ever run a HM in conditions as perfect as these were.I was concerned about using GU during my runs and trained without it. But Anastasia had assured me that it would be ok to suck down GU’s while running since my body would be begging for easy fuel and would literally want to suck all available glucose out of my blood stream, i.e. any sugar that I took in would be immediately put to use. So on race day I sucked down one at mile 4.5 and another at mile 9. I have to tell you that the GU made me feel like Superman – it gave me a serious lift. I actually felt that I could have run harder, but was afraid to out-run my conditioning; I simply had not had enough time to train and condition. As it was, my legs were burning when I crossed the finish line.
My focus now is to get my A1c below 5.7 and I'm tuned into what I eat, how I combine those foods, plenty of workouts, and of course, my Vitamin D. To make that happen I am trying to amp up my activity levels while at the same time limit my carb intake. For example, since the HM I’ve been doing my 5 mile runs in the AM without having anything to eat prior – it is hard, really hard - and by the end of the run I am definitely running on fumes, but my illusion, in my head, I am imagining all those little glucose molecules being vacuumed out of my blood stream. I am also trying to be very conscious of the 18g carb/8g protein ratio, and err on the side of protein. This is somewhat easy when we cook at home, but when going out for dinner, it gets a bit more difficult – but doable.The punch line to all this is that I’m convinced that one or all of the things that I did (what food, how prepared/combined, exercise, and Vitamin D) positively affected my situation. It's all intertwined. As I mentioned earlier, I realize that one good blood test does not a life make, but I am forging on…
My final comment on this is that it has not been hard to eat a specific diet, take a Vitamin D pill, and exercise, but rather that it seemed really, really hard for me to get the right information with regards to what to do, what to eat, what to avoid. With so many people with this kind of condition, this information and steps to take should have been readily available. I'm hoping that this post will provide others in this situation with at least a bit of guidance and encouragement!
Meanwhile, in 6 months I’m looking forward to reporting an A1c level of less than 5.7! Right now my next step is to look for a 10K event to run. Maybe even another Marathon next year!?
