CrossFit South Rockland

Sunday, June 10, 2012

Sean’s Story: Paleo, Type 1 Diabetes & The Endurance Athelete

Hey guys, Diane from Balanced Bites here! Many of you know me from my blog, around the web on Facebook and Twitter or from my Practical Paleo Seminars that I teach in gyms around the country. Well, what you may not realize is that I also coach clients 1-on-1 in their efforts to create diet and lifestyle plans that are unique to their needs and their own specific health conditions. Check out this story from one of my clients, Sean, who came to me back in August of this year looking for help making a Paleo diet work for his half-Ironman race and to get his health (ahem, blood glucose) to a much better, more stable place thereafter.

“Hoooowdy, and welcome to Paleo Town.”

Perhaps it’s fitting that my story starts in rainy Seattle, where Robb first started to develop his work on evolutionary-based nutrition. I was there last December, visiting my friend Erica on the way to Europe for soe desperately-needed travel and vacation. I had just quit my job in politics after a grueling few years (turns out I lack the necessary proclivity for bloodletting, torture, and self-flagellation that the job requires). Seattle was my first stop to rethink my life and my direction. Then it was off to Amsterdam to, uh, not think about my life and my direction, so to speak.
I’d known Erica since high school–she’s always been slim and athletic, and also happens to be one of the smartest people I know. She had recently started CrossFit and running marathons, both of which intrigued me as “good” paths toward “great” health (I would learn later this was naive, but more on that later). When we got to the discussion of diet, she told me that her diet was entirely grain-free. No bread. No pasta. She lived off the fat of the land, literally, to run marathons. I distinctly remember thinking that my friend of over fifteen years may have developed a severe mental condition. Maybe it was something in Seattle’s water supply. I felt increasingly nervous about her mental state when she told me of her plan next year to hunt and kill a wild pig, store it in an industrial meat locker in her “home office” and then cook the captured beast, hooves and all.
While I considered escape routes out of her apartment, we started talking about how I was going to spend the next year. I brought up a couple bucket list items: to finish a double-century bike ride and maybe run a half-marathon. Both of these are potentially complicated goals for most people, but it was even more so for me, as I’m a type 1 diabetic.
My pancreas suffered an autoimmune attack of some sort when I was twenty, destroying the beta cells that produce insulin (among other hormones) and requiring me to dose insulin with any meal.It was a shock to everyone (and myself) when it happened; I’d always been lean and athletic. Played baseball and basketball as a kid. Having to determine a ratio of insulin-to-carbs–as the process of “eating” is known for many type 1 diabetics–is an difficult undertaking due to needing to assess the carbohydrate count in any piece of food and to account the action time of synthetic insulins–even the fastest-acting insulins on the market are a poor substitute for the real thing, taking thirty minutes before they actually start working.
Still, I’d created a system to manage my diabetes and remain active. And according to endocrinologists and other doctors I’d worked with in the past, I was extremely healthy, even compared to their non-diabetic, “normal patients.” I was in better shape than any friend or family member. So I was pretty sure I knew something about energy, metabolism, food, and exercise. Hearing any talk of a high-protein, high-fat diet made me think of my brother’s attempt at Atkins, which, as far as I could tell, consisted mainly of him eating giant bowls of salad while drinking vodka in his boxers and watching “Cops” on daytime television. It’s safe to say that I didn’t hold this kind of diet in the highest esteem.

“How the hell do you have enough energy to run a marathon by eating meat? And fat?” I asked Erica. “And where do you get the will to live…without bread?”

She told me how your body not only becomes “fat-adapted” once you switch to a high-protein, high-fat diet, but cutting out gluten produces other incredible health benefits as well. I had heard the no-gluten spiel before–I’m from California, where Whole Foods actually has an entire section dedicated to cleanses with lemon juice. With accompanying books. Despite being wary of what she was saying and offering her the recommendation of a great psychiatrist, for some reason her talk of an ancestral-based diet made sense to me. It wasn’t that what she was saying was particularly illogical–it in fact seemed very logical– but it was just such radical departure from nearly everything I knew about food. I guess I was just at the right period of my life to be able to consider it. And then I went to Amsterdam and promptly forgot about all of it. Seriously.
Fast forward to June of next year: I was back home in San Francisco. I had decided to take the entire year off from working and take better control of my health. My goals: 1) lose the “tech belly” that about anyone with a computer in the Bay Area suffers from, and 2) train for a half-Ironman–the bike and half-marathon goal weren’t enough, I decided. I had never done any triathlon before, either). This spawned a number of projects experimenting with diet, exercise, and lifestyle changes that increasingly brought me better health in every measurable metric, in addition to how I felt mentally and emotionally. Six months toward that end, I was ready to go deeper, and try some things that I had thought were previously a little crazy. I thought the answer was some crazy-intensity workout program like CrossFit.
I wrote to Erica:
“Hey there. So I’m interested in pursuing a CrossFit program and/or starting a Paleo diet. I’ve been gluten-free for about a month now (with a few lapses) and regularly doing the gym routine (weights, biking, swimming). Have lost some weight and am stronger. Yay. Now I want to [the following said in a Macho Man Randy Savage voice] “TAKE IT TO THE NEXT LEVEL!” Do you recommend getting into paleo with the workout I currently have for sometime and THEN attempting Crossfit, or just get into Crossfit now and work paleo next, or should I just kill myself?”
She wrote back, presumably after returning from stalking a boar in the forest over the weekend:
Hooowdy, welcome to Paleo town. So I was thinking on this problem, and I suspect that getting started with the diet first makes more sense.”
And so like that, she introduced me to the work of Robb Wolf, Mark Sisson, Kelly Starrett, and huge community of like-minded, smart folks. She also said that seppuku is a perfectly valid option regarding the grain detox. I didn’t end up committing ritual suicide, despite listening to every episode of The Paleo Solution (PRO TIP: Play your podcasts at 2x speed! Slow enough to hear and understand normally, half the total time). I picked up The Paleo Diet for Athletes, The Paleo Solution, and just absorbed information. And I tried to put it all into practice.

So there’s the backstory. Where am I now?

For the past two months, I’ve had near-normal, non-diabetic blood glucose ranges. And I don’t mean in the ADA’s warped sense of what a normal blood glucose is, I’m talking about numbers that I think Robb could appreciate. 

And because talk is cheap and electronic type even cheaper, here are graphs from my continuous glucose monitoring system, a handy little device that provides me with an approximate reading of my blood glucose, 24-hours a day.
Perhaps the main take away from these graphs (also linked below) is that my overall mean blood glucose levels have decreased significantly, as did my average blood glucose for any particular hour of the day. For example, back in May, my mean blood glucose was 115 mg/dL, with my blood glucose likely well above 100 mg/dL at any hour of the day. Today my mean glucose is 80 mg/dL, a 30% decrease. That’s a great improvement just in percentage points alone, but in the past six months as I’ve gobbled up numerous studies, reports, and podcasts, what nearly all of them tell me is–in spite of what the ADA recommends– that a truly normal A1c is between 4.6% and 5.3%. It is a world of difference between waking up with a fasting blood sugar of 105 mg/dL and 70 mg/dL, as I regularly do now. I don’t just mean mentally or emotionally, but I feel better in every perceivable physical sense. And in the long term, keeping my A1c levels under 5.3% is likely going to significantly lower my risk of cardiovascular disease.
Chris Kresser wrote a great article about this a while back:
“A number of studies show that A1c levels below the diabetic range are associated with cardiovascular disease. This study showed that A1c levels lower than 5% had the lowest rates of cardiovascular disease (CVD) and that a 1% increase (to 6%) significantly increased CVD risk. Another study showed an even tighter correlation between A1c and CVD, indicating a linear increase in CVD as A1c rose above 4.6%* – a level that corresponds to a fasting blood glucose of just 86 mg/dL. Finally, this study showed that the risk of heart disease in people without diabetes doubles for every percentage point increase above 4.6%.”
After easing into it with Tim Ferriss’s “slow carb” diet, and then using The Paleo Diet for Athletes as a guide, I made the real paleo plunge–that is, no grains of any sort–in August.

Ok, actually I was pushed into the paleo vortex by my nutritionist, Diane of Balanced Bites.

After mentioning that I was diabetic, I think I got about six seconds into listing what I ate before Diane cut me off and told me that Grain Land would no longer be an option. Holy cats indeed, man.

I completely eliminated gluten and grains and nearly all dairy, though I continued to eat some cheese and a little grass-fed butter or ghee. Switching to this diet template not only helped achieve normal average blood glucose ranges, but it has wiped out extreme highs (160 mg/dL and up) and curved postprandial blood glucose down to much better levels. Pre-paleo, in addition to generally running high (above 100 mg/dL), I’d often be between 130 mg/dL – 160 mg/dL for hours after meals.Today, this rarely happens because my blood glucose rarely spikes, period.
The full paleo switch came shortly before attempting the Half-Ironman, which I had been training for pretty rigorously. It was surreal (and a bit frightening) to be eating a breakfast of a couple sweet potatoes slothered with almond butter and a 10oz steak before heading out to an intense five hour event–especially when all the conventional wisdom said that I should have been loading up on carbohydrates. Even though I had tested routines numerous times before the big day, to be committing to a diet so utterly opposed to what nearly every athletic, health, and medical expert has preached your entire life messes with you, to say the least. And when you make a mistake in counting carbohydrate or insulin dosage, you could end up in the hospital.

So how’d I do?

I had enough energy to utterly crush the 1.2 mile swim, beating the majority of people in my age group, and was solid throughout the rest of the event energy wise. My blood sugar was perfectly stable through the entire event. Through a combination of paleo-nutrition principles, a lot of training, and religiously following Kelly Starrett’s, I did pretty damn good.

This shit works.

Some other observations I’ve had from this year:

  • After my blood sugars had been in good ranges for a month or two, I noticed something else: normal hunger pains. I mean that as an incredibly new and wonderful thing. In the past, when my blood sugar dips low, that’s typically when I start think about eating. If you’ve ever been “hangry” you know what I’m talking about. But now I’m getting hungry at predictable times while at a stable blood sugar, like a non-diabetic. I haven’t experienced this sensation in over ten years, before I was first diagnosed as diabetic. It’s actually a different physical/mental feeling as compared to being compelled to eat due to low BG. That signal to eat–and I think I literally mean hormone signaling–was lost in the noise before, but now is really apparent in the midst of all the lifestyle improvements.
  • I’M USING ONE-THIRD THE AMOUNT OF INSULIN I WAS AT THE BEGINNING OF THE YEAR. I hope that perked your ears, diabetic athlete. And keep in mind that I was a pretty skinny, athletic dude to start off with. At the beginning of the year, I was using about 50 units of insulin a day. Now I’m averaging about 20 units a day. This is also awesome financially, because I’m now able to stockpile insulin–in the past I’d never have more than two vials on hand (insurance wouldn’t pay for more). Now I have six. Suck it, Big Insurance Company!
  • I started getting crazy environmental and seasonal allergies starting around when I was 25. They have almost entirely disappeared. I’ve noticed that I start to get a little congested once my blood sugar hits 100 mg/dL. It gives me a way to intuitively know my blood sugar levels without even testing. Nose snuffed up? It might be a sign I want to test. This has held true throughout the year, in the midst of the worst allergy times, during a year where I’ve been outside more often than any other time in my life due to triathlon training.
  • As I adjusted my diet, and then my sleep, and then reduced my insulin dosage, I discovered I experienced what’s known as “dawn phenomenon”–blood sugar spikes in the morning that happen soon after waking. I’d never had it before, or rather, I’d never thought I did, probably because my circulating insulin levels at any given point were always so high, and from my horrible sleep schedule staying up late, my cortisol production had “flipped” (low in the morning, high in the evening) and thus I never noticed it (and I certainly didn’t have an continuous sensor to help monitor). Now that my sleep schedule is normalized, my cortisol production is happening mostly in the morning as it should, I can now account for it, take a quick bolus when I wake up, and keep blood sugars totally normal throughout the morning. Instead of hating mornings–I always liked to sleep in–I’ve become a morning person. Instead of waking up depleted and becoming more alert throughout the day and night, I have energy from the start and naturally tire at the end of day. It’s almost like I’ve become a human being or something.
  • After completing major endurance events in the past, my insulin sensitivity usually decreased for weeks after. I’d need more insulin at meals and circulating my system. My understanding is that this is largely due to the body repairing cellular damage from the stress of the event. After completing my triathlon, my insulin sensitivity was unchanged for weeks. And in fact, despite doing absolutely no exercise for over a month and very little in general these two months after the triathlon, my insulin sensitivity continues to improve. I attribute this almost completely to diet and sleep. It can be difficult to gauge the effectiveness of whether diet, lifestyle, or exercise, or something else as the biggest causal factor for improvements. I’ve focused on changing one thing at a time at various points this year. I started with hardcore exercise. I thought that’s how you get six-pack abs and the cardio health of a Kenyan. I’ve since learned that’s not how you get healthy. Diet has played the biggest part in my health transformation this year, without a doubt. Surprisingly to me, sleep was the next most important, more so than exercise. I’ve been able to achieve better body composition and good health metrics primarily through diet, sleep, and a low stress lifestyle– more so than through exercise alone. Exercise is certainly important, but doesn’t have as much payoff as the diet/sleep/stress triforce. If you have to start somewhere, fix your diet and your sleep first. Then hit the gym and get strong.
Here’s a description of each of the screenshots:
Glucose Distribution – May: My blood glucose level distribution, by percentage, for the month of May. Important note: I set my low blood glucose threshold at 63mg/dL, but in this format, it considers anything under 70mg/dL as “low.” When I’m eating a solid paleo diet and sleeping well, I typically run between 65-70mg/dL fasting with no problems.
Glucose Distribution – Oct: My blood glucose level distribution, by percentage, for the month of October.
Sean CGMS May-Oct-IMPROVEMENT: Here’s essentially a before and after from May, pre-paleo and MANY health adjustments, etc., compared to the month of October, which is after three months of strict paleo.
Sean CGMS May-Oct-AVG: Same thing, but showing average blood sugar values for each hour of the day.
Sean CGMS Sept-Oct-IMPROVEMENT: Before and after between Sept-October. This is interesting because at the beginning of September, I had just finished the Half-Ironman. For the remainder of September, and almost all of October, I did almost no real physical activity. No gym, no swimming, no biking, no running, etc. I was a sloth. Yet my insulin sensitivity actually improved and my average blood glucose went down. In the past, and in the experience of most diabetic athletes, insulin sensitivity usually decreases after a major sporting event like a triathlon. I attribute this to my diet and getting my sleep schedule in much better control.
Sean CGMS Sept-Oct-AVG: Same thing, but showing average blood sugar values for each hour of the day. – Insulin picture: That’s three months of insulin I now have on hand due to lower insulin usage, as opposed to only having a single month on-hand.

Thanks to Erica, Robb, Diane, and Tim. I truly have a new lease on life–a healthy, long-lived one I predict–thanks to you all.

Thanks to Sean for sharing his story. If you have questions for me, contact me via my website here. If you have questions or comments (or accolades!) for Sean, please post them to the comments below.

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