Christian became my patient in February 2017, at the age of 66. He had already been diagnosed with type 2 diabetes, hypertension, and dyslipidemia. He was on metformin at maximum doses, and his HBA1c was 9.2. His triglycerides were at 4.7 mmol/L (416 mg/dl), which is quite high. So high, in fact, that it was impossible to get a LDL count (the so-called bad cholesterol). His blood pressure was also too high, despite his hypotensive medication. He was overweight, at 92 kg/202 pounds, and wasn't feeling well. He wasn't smiling much either. He actually looked defeated.
You'd like me to say that I offered him low carb as a therapeutic option, knowing how powerful this treatment can be, and that it all went well from there, but I didn't. I sent him to see our diabetic nurse. The standard treatment.
I'm not sure why I didn't just talk to him right away about adhering to a low-carb diet. I was in the process of getting my low-carb clinic set up, and I wasn't very good at discerning who would or wouldn't succeed at low carb, and therefore to whom I should offer diet as a therapeutic option.
Today, I am much better at this: I don't try discerning. I have been wrong too many times. I simply offer it, in a well-rehearsed one-minute speech. I plant a seed. I tell my patients that if they are interested in using food as medicine, they should book another appointment with me later on, to discuss this specifically. And I wait and see if the seed grows.
In March 2017, I saw Christian again. His sugar levels were really bad, his blood pressure was still too high, and his lipid profile was pretty ugly. His fasting insulin was also high, as was his liver enzyme (ALT). I added Januvia/sitagliptine (a DPP-4 inhibitor), to improve his glycemic control, and another hypotensive medication.
And then I couldn't help it: I told him he didn't need to be sick if he didn't want to. He didn't need to take medication in increasing doses and numbers. He wasn't condemned. He could choose to get healthy. I gave him my web site as a reference (in French), as well as Diet Doctor's, for recipes.
Progress on low carb
In early April 2017, I saw Christian again. He had decided to give food a try. He had downloaded MyFitnessPal and was actively cutting down on carbs. His blood-sugar levels were dutifully recorded, and were improving already. He was feeling better. He might have given me his first smile on that day.
He came back at the end of April. He had lost 3 kg (7 lbs) and 2 cm (1 inch) off his waist. He had a spark in his eye that I had never seen. He was hooked.
In May, his blood sugar levels had normalised, so I stopped his Januvia.
In June, his blood-sugar levels were mostly in the normal range. His blood pressure was getting too low. I cut his metformin in half, and one of his BP medications in half as well.
In July, his blood-sugar levels were all very nice, and his blood pressure was getting too low again. I stopped one of his hypotensive medications.
In early August, his HBA1c came back at 5.8 (previously 9.2). His liver enzyme (ALT) was back into the normal range.
At the end of August, I cut in half his other hypotensive medication.
He came back in November. He was beaming, and had a spring in his step.
He came back in November. He was beaming, and had a spring in his step. He looked like the picture on the right.We are still working on reversing his diabetes, lipid profile and blood pressure without medication. It's an on-going process, of course. It's a lifestyle. It's now Christian's lifestyle, or his fountain of youth, as he calls it himself!
Here is his weight in kg:
Below is his fasting blood sugar level in mmol/L:
Here is his ALT (liver enzyme) (target is below 40):
Helping patients find their fountain of youth (and fountain of metabolic health) is the most rewarding thing I've ever done in medicine. For 2018, I wish for every health professional out there who is new at this to start offering food as a therapeutic option to their patients (don't worry: you'll learn as you go), and I wish for everyone with health problems related to lifestyle habits to give food a try.
