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A Patient’s Journey: Taming the Glucose Monster

A Patient’s Journey: Taming the Glucose Monster

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In a matter of six months, I went from diabetic levels of A1c to normal levels.

I have a fragmented “team” — including two dietitians, two nurse practitioners, a general internist, a cardiologist, an ophthalmologist, a podiatrist and even a urologist plus scores of Facebook friends — who helped me through this. The health professionals and fellow diabetics have given me kudos and told me this is a major accomplishment. I am grateful.

How did I succeed? I lost about 35 pounds following a low-carb diet with occasional episodes of ketosis, took some dietary supplements for blood glucose issues — plus I addressed my microbiome by combining foods and taking prebiotics and probiotics.

Here’s the chronology.

December 2016: My internist’s nurse practitioner put me on notice that I was heading into dangerous territory with a fasting blood glucose of 102 ng/dl. I had been diagnosed with prediabetes. The NP said I ought to lose weight and watch what I ate.

In one ear and out the other, I didn’t take it seriously.

June 2017: My blood glucose had reached 141 ng/dL. I had my first A1c test: 7.8%. I had full-blown diabetes.

I sprang into action. I went on metformin (2,000 mg/day). I started on a low-carb diet and began dropping weight. I might have done better — I shied away from the gym because of a backache. Still, I started to get good numbers from my daily fingersticks.

September 2017: I was down about 20 pounds, I had returned to a prediabetes level — with an A1c of 5.9% and a fasting blood glucose of 90 ng/dL.

My ophthalmologist and podiatrist both encouraged me to go for normal and potentially go off metformin. But following American Diabetes Association guidelines, my internist recommended I stay on metformin and go for an A1c in a range 6-7%. He was concerned I would go too low and create other problems.

Meanwhile, a couple other things happened.

November 2017: My wife Judi and I went on a two-week Viking Ocean Mediterranean cruise to Greece, Israel, and Italy followed with another nine days on land in Rome, Florence, and Venice.

Cruises are notorious as diet-busters with champagne dreams and infinite buffets. And how could I go to Italy without indulging in pasta, pizza, and gelato. That would seem to be a crime against nature. So, I had a taste.

And some surprising things happened. I found I had good blood glucose readings when I tried some foods I had considered verboten, including rice, bread, and pasta. I tried a salmon maki roll. Despite the rice, I had a blood glucose reading in the 80s. I had meat lasagna in Rome and got a reading in the 90s.

I got an explanation later.

December 2017: I lost more weight — at 175 lb, down nearly 35 and at an appropriate BMI based on my age (I am 70 and stand 5’8″).

Could Microbiome Therapy Help?

Now it’s time for something completely different: I started to explore my microbiome, that three-to-four-pound collection of trillions of bacteria, viruses, fungi and other microbes that help regulate their host’s immunologic, hormonal and metabolic functions.

I had been researching a story on the emerging microbiome testing industry for a European publication for microbiologists.

Two of the top American microbiome experts and a distant cousin of mine, an MD, urged me to take a specific test from DayTwo.com. The researchers said DayTwo’s product is based on world-class research by microbiome experts from the Weizmann Institute of Science in Rehovot, Israel.

I ponied up $300, prepared my stool sample, shipped it off and waited.

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I also had an opportunity to take a complementary beta test of my microbiome by another consumer-oriented company, Viome in Cupertino, CA.

In fact, there are a growing number of companies in the field. They use different techniques and as a result can result in different results in the make-up of the microbiome in your gut.

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Their goals are different. Viome, which licenses its technology from Los Alamos National Laboratory, using artificial learning engines.

Viome’s test, a subscription of $399 per year, aims to help its customers “achieve maximum health & wellness” as well as helping people with diabetes and gut diseases.

DayTwo’s test has a narrower goal. It is designed to manage blood glucose.

I won’t get into all the minutiae of the teeming billions of active and inactive microbes sharing space in my gut.

I found clear dietary differences in recommendations.

Viome suggested that I can “indulge” in certain foods, enjoy others, and avoid still others based on my microbiome and my metabolism.

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DayTwo rates foods based on your microbiome and other factors, giving letter grades to different foods and meals.

There many discrepancies to say the least. DayTwo gives an A+ to starfruit, while Viome suggested I minimize consumption. (I’m no fan of starfruit, anyway.) DayTwo gave an A+ to butter, duck and tuna, which Viome suggests I minimize.

Viome terms apples as a “superfood” for me while DayTwo gives them a C-.

I generally have avoided fruit lately. One exception is strawberries, which DayTwo gives an A+ and Viome tells me to “enjoy,” in a rare instance of agreement. But blueberries are another story. Viome says I can indulge while DayTwo gives them a B-.

Looking at the conflicting food recommendation, I got a cognitive-dissonance-triggered headache. Really.

Most microbiome testers probably don’t take multiple tests so they don’t know the difference. The companies explain they use different lab tests so they get different results and algorithms.

I did make a change based on a conversation I had with Debra Heald, an RN and naturopathic physician and team leader for translational science with Viome. She suggested I add a probiotic and a prebiotic to my regimen. I did.

I should point out that many other experts contend the science isn’t there yet to shape our microbiomes by taking such supplements.

But something Chavi Kramer, a clinical dietitian at DayTwo, told me rang true. It helped explain my good results with salmon maki on board the ship and lasagna in Rome. I inadvertently mixed those foods with others with high fat and/or high protein and controlled my blood glucose.

She noted that the DayTwo algorithm can be used to create meals that mix foods for maximum benefit.

For example, I found that having lox with cream cheese on a bagel was a winner.

A medium bagel scored a C-. Not surprising. But add a hearty dollop of cream cheese (A+) and a couple ounces of lox (A+), and you get an A-rated meal.

I had just about given up on ever having one of my favorite meals. I could kvell.

I saw Gwen Woodruff, my dietitian who specializes in diabetes. She found that over the previous three months, including the cruise, my weight had dropped and my A1c was 5.5%. Normal. Surprisingly, to me anyway, even my prostate cancer numbers improved dramatically.

As an unscientific experiment over the prior two weeks, I wore a continuous blood glucose monitor, which Medicare covered.

Woodruff found that over the two weeks I included DayTwo plus the prebiotic and probiotic recommended by Viome, I had an average blood glucose of 103 and an estimated A1c of 5.2%.

One of my distant cousins said on Facebook, “tamed the monster.” Great success.

I plan to improve things by stepping up my exercise. I am making an addition to “Team Howard.”

I have an appointment in January with an endocrinologist at the University of Illinois at Chicago who also is a microbiome researcher. I want to see what he suggests I do to keep the monster under control.

1969-12-31T19:00:00-0500

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