They care about your payments, more likely...
He said that level of consistency was fantastic, that at least a third of his patients flat-out told him they hadn't done any of the exercises at all, another third showed no improvements above baseline and he suspected they had lied about it, and the remainder had moderate compliance. When he'd told me 6x/day, he was anticipating 2x on the high end. We adjusted to 4x/day, where morning, lunch break, after work, and before bed were easier habits to stick to than trying to drop and do press-ups in the middle of my 9:00 meetings.
And that's at a sports and fitness-focused PT organization, not an average general practitioner working with median diets and advising a society that by default trends towards diabetes.
Eat less, exercise more, and you may delay T2D. Reduce or avoid fast carbohydrates. Reduce carbohydrates.
Strict carnivore for me was steak, hamburger, stew meat fried in butter, mushrooms and onions in butter, bacon, and very sharp cheddar (only on burgers or raw). Eat every bit of gristle and fat. It is very hard to get enough fat.
Brain fog lasted for 10-11 days. Felt fantastic after that.
To keep your carnivore costs down I would recommend stew meat from Costco fried with onions and mushrooms when you can't stand steak or plain burgers.
This has worked for me for the last 6 months. I have no idea what it will be long term. Maybe someone will find something useful in it.
Their experience touches on 3 factors:
>Exercise volume (which, according to newer research, should be spread out over the course of the day)
>Diet (which should be focused not just on maintaining steady, low blood sugar levels, but on dietary factors that encourage subcutaneous rather than visceral fat deposition)
>Sleep quality
The last, I think, is extremely undervalued. My father developed T2 in his 30s, and it progressed consistently until he was diagnosed with sleep apnea and received treatment. Around the same time, his work schedule finally became more reasonable after a career of early mornings and late nights. This is someone who had to pass annual physical fitness exams for his job, cooked and ate relatively healthily, etc. I'm convinced it was the years of poor sleep that set him up for insulin resistance.
This publication is a good starting point to his approach. Early time-restricted eating of low sugar and low starch meals is the key: https://nutrition.bmj.com/content/bmjnph/early/2023/01/02/bm...
My philosophy is that many diets work, you just can not have a cocktail. Our body is not a hybrid car. It takes time to switch/
Choose what you can live with - high carb, low carb, keto - and stay focused.
As for plant based versus animal based diets, we don't have any high quality RCTs to indicate that one or the other has a different impact on insulin resistance (assuming the same macros). So that's unlikely to be directly relevant for most patients, except to the extent that it impacts ease of living permanently maintaining carb restriction.
It sucks, and I wind up cheating 2-3x a week (I live with people that eat different than I do).
- compliance is straightforward
- on average, will tick all the boxes for nutritional needs. (ie. vegans eating only oreos would not be very healthy, while vegans eating 5 colors a day would be far better off)
Also the FDA cleared at least one brand of CGM to be sold without a prescription, starting "summer 2024": https://www.dexcom.com/stelo
You should expect to pay $80 - $200 per device, and they last one 14 days, but the insight they give is really worth it.
- Exercise: 'Exercise plays a major role in the prevention and control of insulin resistance, prediabetes, GDM, type 2 diabetes, and diabetes-related health complications. Both aerobic and resistance training improve insulin action, at least acutely, and can assist with the management of BG levels, lipids, BP, CV risk, mortality, and QOL, but exercise must be undertaken regularly to have continued benefits and likely include regular training of varying types. ' - Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2992225/
- Intermittent fasting: there's great evidence that IF (intermittent fasting) can put it in remission: https://www.endocrine.org/news-and-advocacy/news-room/2022/i...
- Minimally processed and ketogenic diet: avoid foods which have sugar or high-fructose corn-syrup and mostly stick to low-glycemic index minimally processed foods. 'Diets with a high glycaemic index and a high glycaemic load were associated with a higher risk of incident type 2 diabetes in a multinational cohort spanning five continents. Our findings suggest that consuming low glycaemic index and low glycaemic load diets might prevent the development of type 2 diabetes.' - Source: https://www.thelancet.com/journals/landia/article/PIIS2213-8...
- Take a teaspoon with turmeric + black-pepper daily: 'Clinical trials and preclinical research have recently produced compelling data to demonstrate the crucial functions of curcumin against T2DM via several routes. Accordingly, this review systematically summarizes the antidiabetic activity of curcumin, along with various mechanisms. Results showed that effectiveness of curcumin on T2DM is due to it being anti-inflammatory, anti-oxidant, anti-hyperglycemic, anti-apoptotic, anti-hyperlipidemia and other activities. In light of these results, curcumin may be a promising prevention/treatment choice for T2DM.' - Source: https://www.preprints.org/manuscript/202404.1926/v1
My lowish tech solution to delay (and hopefully prevent!) the onset of T2 is to use a glucose monitor every 2 hours, every day, and create a database of foods with my postprandial blood sugar reaponse at 1.5 and 2 hours. I also keep track of how exercise affects my blood sugar.
Over the last couple years, I have gotten great data on the foods which spike me and the foods which are neutral to my blood glucose.
A lot of foods doctors/the internet tout as "diabetic friendly" (like beans, lentils, corn in any form, brown rice, buckwheat groats, non-granny-smith apples) spike me like crazy. Other foods are totally fine (bananas, snap peas, nuts, steel cut oatmeal, fermented dairy, fish).
Having an autoimmune disorder on top of the prediabetes, I've learned that the only one who cares about my health and longevity is me. My doctors care about my inflammatory markers and nothing else.