In my last post at the end I mentioned that I’d gotten back blood work and it wasn’t all pretty.  Many markers that were bad before – B12, iron, testosterone, AST, ALT, … were now in good shape and my systemic inflammation as measured by CRP was very low but I had a few things that were not so good – cholesterol and blood glucose.  The cholesterol numbers had gotten worse in a year since my last check but even then they don’t concern me too much.  The HDL number is good and high, the HDL/Triglyceride ratio is good and the LDL particle size actually got bigger.  Thus all the cardiovascular risk factors they show on the test come out on the very low end of the very low risk scale.   So, even though my total cholesterol is at 299 (up from 254 last year) there isn’t a real cardiovascular risk here, especially given my inflammation as shown by CRP is only 0.27 which is extremely low.

The blood sugar number though took me by surprise.  I’m Paleo and I have a high blood sugar measurement, 105, that actually put me in the pre diabetes range.  My A1c which measures how long the blood sugar has been high was also high though only 5.7 when the normal range runs to 5.6 which means things haven’t been high for too long.  The good news is that my Insulin Resistance Marker came out very low and running my 23andMe through Interprtome.com‘s T2D risk analyzer showed I only had about a 22-25% risk of developing T2D based on several SNP studies.   Looking back at previous labs I find that my fasting blood glucose has been on the very high side of normal ever since I got SIBO.  Before that it was 84, now it seemed to have always been in the high 90’s, like 97 and 99.  Once it was even 115 and no one said a thing about that.   Did SIBO jack my metabolism totally?

The number fits though and the reason I went in to get the blood work done was because I’d been experiencing a few symptoms which fit with the pre diabetes state:

• hunger – I eat such a high fat diet that I’m usually not hungry but lately had been getting hungry between meals
• inability to gain weight even though eating more – I’d dropped back into the mid 150’s from a high of 161.  Granted this could be from running and more efficiently burning fats but I just can’t gain weight regardless of how much I eat.  This of course led to more carbs in an attempt to put on weight which probably aggravated the problem.
• thirst – I’ve been thirsty as hell lately and not just on hot days, my throat always seems dry.

Now, what could be causing this?   Carb creep is probably partially to blame.  I’d been eating more 85% dark chocolate, yes it has carbs.  I’d been eating more homemade ice cream or homemade puddings all in an attempt to put back on some weight and yes, those have carbs since I was using honey and maple syrup to sweeten them.   As my friend Shari said yesterday, “You talk about ice cream more than anyone I know.”   I’d also been eating at least one, sometimes two, bananas a day and they are heavy carbs.  White rice and several servings of sweet potato a day probably didn’t help either not to mention the occasional white potato.  Yes, I’d been pigging out a bit on carbs pretty much daily but still, compared to the Standard American Diet I was low carb, one good sandwich probably has more carb than I got in an average day.

High cortisol is probably also to blame.  I know my cortisol levels were off the charts high in the middle of the night and morning and off the charts low late in the day.  This is still probably not under control and high cortisol leads to high blood sugar.  Add to this the fact that I do a 12-14 hour fast every night and I can easily be raising my blood sugar – see Chris Kresser’s post on Intermittent fasting, cortisol and blood sugar.  Kresser also sees people with high blood sugar who are doing Paleo so I’m not the only one having this issue.

So, what to do about it?   My primary care doctor recommended cinnamon and chromium as a good starting place.  Chromium helps to wake up the insulin receptors which could help uptake more of the glucose into muscle.  Cinnamon evidently is very good at regulating blood sugar and can drop values quite a bit.   I found this great infographic on keeping pre diabetes from turing into T2D and they have even more suggestions:

• Apple Cider Vinegar (ACV) – you need a little over a tablespoon per day to help reduce and regulate blood sugar.
• Lose Weight – well that ain’t happening and I don’t need to drop any more weight at all, I need to gain.
• Exercise – I do this regularly.  Interestingly too much exercise, especially endurance work can increase cortisol which raises blood sugar so I’m keeping my mileage reasonable and forgetting long runs for a while.
• More Sleep – working on this too, again I think my sleep issues are tied to high cortisol so if I can solve that one I hopefully can solve all of this.

The last resort, of course, is Metformin, and I don’t really want to go there.   I need to start monitoring all this so I bought an iHealth Glucose Meter because I’m a geek and will start to check my fasting blood sugar as soon as it shows up.  I may track it during the day some too just to see what is going on.

The other thing I’m doing is the DUTCH test.  This stands for Dried Urine Test for Comprehensive Hormones and seems to be the best cortisol test out there.  Interestingly Ben Greenfield just did a podcast on the DUTCH test a few weeks ago and his cortisol is high as well as his blood glucose.   In more of a coincidence his podcast last week was all about sleep but also blood sugar and cinnamon and ACV came up in that one too.

So, in the last few days since researching all this I’ve made some changes and we’ll see if that gets my blood sugar back to normal ranges.

• I cut out a TON of carbs.  Gone is my honey and maple syrup sweetened desserts, I’ve made new Bulletproof pudding with stevia.  I ditched my 85% chocolate bars and moved to 100% again, 0 carbs there.  White rice is gone for a while, I did have some brown jasmine the other day and I’m fine with it so if I want rice I’ll go with that.  I’ve cut out sweet potatoes a bit, I’ll have them one meal a day but not two or three.  Bananas are gone, I’ll stick with berries and lower carb fruits.   I’m trying to go very low carb during the day and then eat carbs in the evening meal, another tip from my buddy Ben.
• I’m adding cinnamon in supplement and in spice form.  I’m adding cinnamon to my morning coffee now and taking about 1g per day in supplement form.  I also added cinnamon to my pudding which made it really good.
• I’m taking the chromium supplement too.
• I’m using ACV more.  I add some to my salad dressing now along with balsamic and since I eat salad at least once a day this gives me a decent dose each day.
• I’m weaning off caffeine again.  I lived without it for 2 years, I can live without it again.  Caffeine raises cortisol and even though I only had one latte each morning I can have that latte with decaf to still get my morning coffee w/o the cortisol raising effects.
• I’ve cut out my long fast at night.  I’m eating a snack before bed now, usually 5-6 Epic Bites and a small pile of nuts.  This should keep my blood sugar regulated a bit and also, maybe, help me sleep better through the night.

We’ll follow this for a bit, start monitoring, do the DUTCH test and redo the blood work in a few months.   Stay tuned, there will be more results coming soon.