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A blog on fasting, health, and other issues of midlife

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Glucose might not be the cause of Type 2 Diabetes

There has been a long-standing belief that consuming too much sugar was the cause of Type 2 diabetes and that treating diabetes was about controlling blood sugar.  Makes sense, right?  Well, it’s more complicated.

Recent research has now provided evidence that mitochondrial dysfunction (previously covered on this blog) — involving fats, not glucose — may be to blame for the inflammation which causes type 2 diabetes!

Warning: In no means does this post advocate any stoppage of treatment for blood glucose control.  The recent research just reveals that there is more to the story.

Inflammation and Type 2 Diabetes

For context, it has long been demonstrated that there is an association between inflammation and the onset of Type 2 diabetes.  A 2001 study published in JAMA stated the following:

Our epidemiological observations, coupled with emerging experimental evidence, support a possible role for inflammation in the pathogenesis of type 2 DM. Our data also raise the possibility that inflammatory markers, like CRP, might provide an adjunctive method for early detection of risk for this disease.

As research progressed, refined conclusions made their way from research publications into the popular press.  A Scientific American article from 2009 described this phenomenon:

Researchers have since shown that TNF-alpha—and, more generally, inflammation—activates and increases the expression of several proteins that suppress insulin-signaling pathways, making the human body less responsive to insulin and increasing the risk for insulin resistance.

This phenomenon was summed up well in a review of a 2014 study where the editor of the Journal of Leukocyte Biology wrote:

The more researchers learn about obesity and type 2 diabetes, the more it appears that inflammation plays a critical role in the progression and severity of these conditions.

The real question then was what causes the damaging inflammation?

Understanding the Cause of the Inflammation

It has been assumed that high blood sugar levels were to blame for this inflammation in diabetic patients and that achieving healthier blood sugar levels was the key to reducing inflammation.  However, the recent study cited earlier challenges this assumption.

With the initial assumption that glucose caused the inflammation, the researchers Barbara Nikolajczyk from University of Kentucky and Douglas Lauffenberger from MIT hypothesized that immune cells from patients with type 2 diabetes would produce energy by burning glucose.  The team was surprised to find that glycolysis, a reaction involving glucose for other types of inflammation, was not driving chronic inflammation in diabetic patients. Instead, a combination of defects in mitochondria and elevated fat derivatives were responsible.

Solving a Long-Known Mystery

One long-known mystery in diabetes control emanated from the ACCORD (Action to Control Cardiovascular Risk in Diabetes) study back in 2008.   It compared intensive therapy (HbA1C levels below 6.0%, similar to a non-diabetic patient) with standard therapy (HbA1C levels between 7.0% and 7.9%). The conclusion was surprising in that mortality rates increased with tighter blood glucose control.

As compared with standard therapy, the use of intensive therapy to target normal glycated hemoglobin levels for 3.5 years increased mortality and did not significantly reduce major cardiovascular events. These findings identify a previously unrecognized harm of intensive glucose lowering in high-risk patients with type 2 diabetes.

This increase in mortality ultimately resulted in the early halting of the glucose-control arm of the ACCORD trial.

A follow-on study to ACCORD (ACCORDION) invited all surviving ACCORD participants who were later treated according to their health care provider’s judgement.   Once their data was collected, the study revealed that the period of intensive treatment during ACCORD did not help in the long-run.

In high-risk people with type 2 diabetes monitored for 9 years, a mean of 3.7 years of intensive glycemic control had a neutral effect on death and nonfatal cardiovascular events but increased cardiovascular-related death.

While there was well-documented analysis on ACCORD and ACCORDION, there remained a mystery of exactly why lowering blood glucose back to normal levels didn’t produce the desired effects.  This latest study may begin to unravel some of the mystery.

As noted by the study authors…

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Steve Pao on #PopHealth podcast

Fasting, diabetes, and innovations in health were just some of the topics I covered during my visit on the #PopHealth podcast titled “Personal and Organizational Well-being.”

Here are the links to the podcast on the various platforms:

For those who haven’t listened to the #PopHealth show before, here is the description:

This show is about all things population health. What is population health? It is about making populations and groups healthy. If you are someone who feels accountable or responsible for other people and their health- this show is for you.

Personal Well-Being

Here are some of the references I made during the podcast.

Also, I reference Mark Sisson’s Mark Daily’s Apple blog.

Organizational Well-Being

As the podcast shifted to business, I discussed how  I named my own consulting practice (Hillwork, LLC) for early-stage technology companies after the concept in training workouts for improving performance.

The analogy to “hillwork” in business is the exercise of finding product-market where the 1990’s version of this was chronicled in  “Crossing the Chasm”, a classic book of the time by Geoffrey Moore.

Some of the companies I mentioned about using technology to improve outcomes were:

  • Otonexus – featuring an air-coupled ultrasound device to detect ear infections
  • Light Line Medical – featuring use of visible light (not drugs or chemicals!) to kill bacteria in catheters
  • Pixamed – extending cloud and mobile to electronic medical records systems beyond big hospitals but to clinics and skilled nursing facilities
  • Health Hero – a platform focused on using software to improve patient follow-up and improve outcomes

Here’s also the contact information he asked for:

Overall, thanks to Anthony Diaz to having me on the show!

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26 Fasting Days Completed!

I’m now turning the corner of this second round at the Buchinger Wilhelmi fasting clinic here on Germany.  Now that I’ve been through 26 days of fasting this time around, “re-elementation” or “refeeding” is now the most important part.  The body has torn down the old, bad stuff through fasting.  I’m down over 20 pounds (spreadsheet here).  Now it is time to rebuild but with the right foods!

I know from experience that this rebuilding is the hardest part.  After 4 days of eating foods provided by the clinic, the hard part is coming home and staying very healthy for the next two weeks and beyond.

Everyone always marvels at the extended fasting, as the fast itself is the experience they can’t imagine.  Buchinger takes care of that part.  Doing the right thing is up to you and your support infrastructure around you.  Most people fail at that part.  Buchinger Wilhelmi has many repeat visitors who simply use the clinic as a recurring reset operation because of the challenges of maintaining the discipline at home.

As a second time visitor, I hope not to need to spend the time and money here for periodic resets!  Still, I have to understand that 2 months of extended fasting in the last year may simply not be enough…

In Chapter 15 of The Diabetes Code, Canadian nephrologist and fasting expert Jason Fung (whose Intensive Dietary Management program I’ve mentioned here) provides further encouragement:

Certain general principles apply to fasting with type 2 diabetes.  How long it takes to reverse the disease depends on the intensity of the fasting regimen and the length time you’ve had the disease.  More intensive fasting will give quicker results, but if you have type 2 diabetes for twenty years, it is unlikely to reverse in several months.  It will take longer, though the exact time differs from patient to patient.

So, this will be a process!  Wish me luck!

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Exercise — integral to the Otto Buchinger fasting method

Yes!  You can do a fasting program and still exercise!

There are different schools of thought with respect to fasting.  On one extreme is pure water fasting, such as practiced at Goryachinsk on Lake Baikal in Siberia.  In this program, exercise is not compulsory.

Otto Buchinger, on the other hand, created his fasting program 100 years ago with the thought of providing patients a small calorie intake but augmenting with daily walks as exercise.  The idea behind providing of limited food (250 calories per day) with exercise is to make fasting more accessible, with fewer side effects.  Daily walks in the forest  (or Wanderung as they refer to them here) are every day, rain or shine.  With a little bit of nutrition, people do have the energy to exercise!

Buchinger Wilhelmi Wanderung
View from a daily walk (Wanderung) at Buchinger Wilhelmi

The clinic is currently managed by the fourth generation of the family, and Otto Buchinger’s descendants have since further updated the program to augment the daily walks with an indoor fitness center.  It’s a pretty sophisticated facility with great views of Lake Constance.

Buchinger Wilhelmi Fitness Center
Buchinger Wilhelmi Fitness Center

I just wish the fitness center opened earlier in the morning!  The walks in the summer start at 6am, and the fitness center would have been a great alternative to walking in the rain!

Buchinger Wilhelmi Fitness Center Hours
Buchinger Wilhelmi Fitness Center Hours

For me, this month of fasting resulted in a personal record on my Garmin step counter, with over 600K steps in May, 2019.  It also capped a personal record of over 5M steps in the trailing 12 months!  In the month of May for me, 25 of those days were fasting!

Step Count During Buchinger Wilhelmi Fasting Clinic
Step Count During Buchinger Wilhelmi Fasting Clinic

Note that the daily walks are typically only about 4 miles for “Group A” (the fastest group of three), so you don’t have to break any records to participate!  That said, after the morning walks, we just enjoyed walking around the lake and on the trails around the town, too!  It’s really beautiful in this part of Germany when it’s not raining!

Walking on Lake Constance
Walking on Lake Constance
Walking on the trails in Überlingen
Walking on the trails in Überlingen

We were also able to squeeze in a 10K (the Volksbank Überlingen Lauf) in town.  It certainly was not my fastest 10K ever (actually my slowest race), but I was able to complete it with a sub-10 minute per mile pace — even after 12 days of fasting!

Finisher Certificate - Volksbank Überlingen Lauf
Finisher Certificate – Volksbank Überlingen Lauf

So don’t be afraid to fast!  You will have a lot of energy!

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Resting metabolism not slowing…

I have known for quite some time that my system just wasn’t totally efficient, as I could eat an above average amount of food and not gain weight.  While many might envy having this problem, my unusually high metabolic rate was actually a bad sign.

Many (pretty old!) studies have shown that Type 2 diabetics actually have a higher resting metabolic rate than non-diabetics and the high metabolic rate is associated with the progression of the disease.

Examples:

More recently, it was discovered that with no changes in body type, this resting metabolism rate doesn’t respond to interventions, such as interval or continuous training either in an attempt to reduce it.  In other words, this high metabolic rate is pretty stubborn!

So far, I’ve completed 17 fasting days (19 total days) here at my second stay at Buchinger Wilhelmi. I started at roughly the same weight (actually 2 lbs heavier!) as last time, and I am losing weight at roughly the same rate.  After 19 days, I’m down 8.5kg (18.7 lbs).  Last time, by Day 19, I was down 7.9kg (17.4 lbs).

So why is this significant?  I had noticed how easy it was for me to gain all my weight back after fasting.  I was hoping my resting metabolism had slowed — a potential sign of reversal of the disease. Seeing my weight loss patterns with fasting this second time, this is apparently not the case!

Still the aim for this second round of fasting is to get the benefits of autophagy and mitophagy from the fasting as well as the benefits for promoting the diversity of my gut bacteria.

Something has changed in me given my fast return to normal blood glucose levels and blood sugar in a shorter amount of time. However, resting metabolism doesn’t appear to be one of them…

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Back at Buchinger!

Life got in the way, and this is my first blog post of 2019. I’m writing this post on a return visit to the Buchinger-Wilhelmi fasting clinic in Germany. The clinic provides an excellent venue for a mental “reset” to capture thoughts and reflect back on life outside of the day-to-day!

Returned to share with family

The primary motivation for returning to the clinic was actually to share the fasting experience with our college-age daughters. Fasting is a centuries-old tradition (often accompanied with religiosity) which modern American society has stifled.

I’m currently at the clinic in Germany with our older daughter (rising college senior) who is on a 14-day program. My wife and our younger daughter (rising college sophomore) will join us after 10 days for a 21-day program. While our older daughter has to return the US, I will stay on the whole time, making for a total of 31 days for me!

I am staying a total of 31 days here!
I am staying a total of 31 days here!

Needed the visit for myself!

It turns out this visit to the clinic was well-timed.  My weight (and the rest of my statistics) have largely reverted back to levels prior to my last visit to this clinic. Here for example is a graph of my weight, showing it returning to the level I was at before the clinic visit last year!

Weight Gain Since Buchinger 2018
I gained back all the weight since my last stay at Buchinger in 2018!

Along with the weight gain, some other health indicators came back, too.  😢  More on this later!

High-level impressions

After completing the first 8 days of the program (arrival day, digestive rest day, and 6 days of fasting), I am reminded of the pros of the clinic and have picked up on (or been reminded of) some cons.

The pros

  • The fasting program. Buchinger offers a very repeatable plan to make long periodic fasts approachable for everyone.  (I documented day-by-day experiences from my first visit previously on this blog.)I am personally down 4.2 kg (9.24 lbs) so far.  My older daughter has also been successfully fasting!More significantly, my fasting blood glucose returned to normal levels (below 100) in 4 days with no drugs. This blood glucose normalization is a significant improvement over my first visit when it took 12 days for my blood sugar to return to normal!  For this visit, I’m logging my statistics in an Excel Online spreadsheet.
  • The operations.  Overall, this German clinic in Überlingen is very well run across the medical staff, nursing staff, labs, dining room, housekeeping, therapies, and facilities. (I have not been to the Buchinger-Wilhelmi Spanish clinic in Marbella).
  • The guests.  The patients come from all over the world and make for interesting conversations!

The cons

  • The weather in May.  This part of Germany can get COLD and WET. Visiting in August was nicer than visiting in early May.  Even when it was raining here before in August, it wasn’t so cold.  In our first eight days here, the weather has made the early morning walks uncomfortable (it was 36℉ / 2℃ on our first walk this visit!) and has discouraged participation in outdoor activities during the day.That said, we’re here to fast, and that part is going well!
  • The repetition.  Revisiting the clinic feels a bit like the movie “Groundhog Day.” Part of the power of Buchinger is that they know how to use repetition and routine to foster “duration neglect” allowing the mind to handle a fast of a long duration.  The problem is that this subsequent visit feels like a continuation of the first one. The program, the daily hikes, and most of the content are basically all the same from year to year.Still, most people here don’t seem to mind the repetition.  I’ve heard that 65% of the visitors here are repeat visitors, and this statistic matches with my experience taking to people on an ad hoc basis. In one discussion group of 6 people, everyone in my group except for me had been to the clinic at least 4 times! On our last visit here, my wife and I met a gentleman from Egypt who had been here 37 times!
  • Cost.  With our credit card bill coming due during our visit, I am reminded of how much money this place costs. Ouch!Still, this price for this stay for the four of us is cheaper than potential long-term medical bills or even a semester of private college tuition, room, and board!  And, to be fair, there are costs on the clinic’s side, as there are about 300 very professional employees on staff to serve just over 160 patients at a time.

Watch this space

While I do not plan to post as frequently as last year, I’ll continue to update this blog with impressions from our second visit to Buchinger Wilhelmi!