Why I’m Doubling Down on Low Carb, Intermittent Fasting in 2019

I’m not much of a New Years resolution guy, but it’s hard not to think about the year ahead as the new year approaches. When it comes to my diet plans for 2019, I feel the need to echo the late George Herbert Walker Bush during the 1988 presidential campaign — stay the course.

All of my reading and research last year led to my full adoption of a low carbohydrate lifestyle, and nothing has changed that would lead me to rethink this approach. I’m not a doctor, but I’m fully confident that my cardiovascular health improved over the course of 2018. A year-end visit to my cardiologist confirmed my own analysis. In December I had an echocardiogram, a nuclear stress test, and a blood workup and all of these diagnostics returned very positive results.

The biggest danger for a heart attack survivor like me is to have a second cardiovascular event. In the first few years following my near fatal event, my heart performance was stable and improved a bit. My blood work was better, if not perfect, and all the other tests showed incremental improvement. Most importantly, my ejection fraction (my heart’s ability to pump blood out to my body) went up each year.

At the time of my heart attack, my ejection fraction (EF) was measured at around 30-35 percent. An EF of less than 40 percent may be evidence of heart failure or cardiomyopathy. For me, this was the scariest aspect of my event. It was also what has been driving me to make changes to my lifestyle.

Improving my EF has provided positive reinforcement for the things I’ve been doing to improve my cardiovascular health. I know that lifestyle led to my heart attack, and therefore lifestyle could keep me from having another one. This is why I’ve spent the past seven years exercising more, taking my prescribed medications, seeing my cardiologist regularly, and eating right.

Honestly, the only aspect of the above lifestyle changes that have provided any complications for me over the years since my heart attack has been eating right. I truly believe the medical establishment either doesn’t know or doesn’t want to suggest how to eat appropriately for cardiovascular health (I think they don’t want to provide advice because it is not so clear cut and if they are wrong they may be worried about liability). All the proof you need that the medical establishment doesn’t know the best way to eat is to Google diet advice — you’ll go down a rabbit hole from which you may never surface.

After my heart attack, my first cardiologist told me to avoid sodium because high blood pressure can lead to heart failure and/or cardiomyopathy. In that first year I avoided sodium like it was poison. Do you have any idea how hard it is to limit sodium intake to less than 1,500 mg a day?

But sodium didn’t cause my heart attack, so I spent a lot of time researching the latest medical advice on diet. I was really frustrated with what I found. I read about the China Study and Dr. Caldwell Esselstyn and thought perhaps meat was the cause of heart disease. I became a pescatarian, eliminating all meat except for fish. Then research started to point to the Mediterranean Diet as the best overall diet and that seemed reasonable so I went down that path. My blood work was better, but still not where I needed it to be.

I watched every movie about diet from Forks Over Knives to Fed Up to Fat, Sick and Nearly Dead and all I got was more frustrated and confused. But as time went on, I started to notice a trend — there was more and more information out there about the dangers of carbs and sugar. I really honed in on this trend, reading everything I could get my hands on. At the same time, I started working with a new primary care doctor who also believed that carbs and sugar were the real culprits of diseases like diabetes, metabolic syndrome, and heart disease.

I jumped in to the low carb movement under doctor care and with regular blood work checkups to assess how I was doing. And for me, the results have been compelling. My blood work is enviable by any standard, and my weight is in a good range. Best of all, my EF has continued to rise and last month was measured at between 60-65 percent — the best it has been since before my heart attack and within the normal range.

As of today, I have above average blood work and a normal EF. That’s all I could have asked for seven years post heart attack. I may cheat here and there (I do enjoy a beer now and again), and my sugars are not as low as I’d like them (that’s where the intermittent fasting is hopefully going to help), but basically, I am in great cardiovascular health. And I’m enjoying how I eat, which is to say I get to eat a wide range of foods including meat, eggs, and a little whole grain bread.

So here I am in January 2019 with probably the best cardiovascular health I’ve had since I was a teen. I attribute this to exercising more, taking my prescribed medications, seeing my cardiologist regularly, and eating right — that is to say, a low carb, low added sugar diet. I definitely need to exercise a bit more, but for the first time in a long time, I am confident I am eating healthy.

Intermittent Fasting Off to Metabolic Slow Start

Three months ago, in an effort to reduce my fasting glucose levels and hemoglobin A1c which are slightly elevated, I added 16/8 intermittent fasting (IF) into my diet routine. The idea was that by not eating during a 16-hour window each day, I’d lower my insulin resistance and bring my sugars into a more normal range.

It’s worth noting that my sugars were not too high (109), but rather near the top of the normal range (less than 100) butting up against the pre-diabetic range (100 to 125). My A1c was 5.2, within the normal range, but not too far away from the prediabetic range of 5.7 or above. With my cholesterol and triglycerides in wonderful shape thanks to my low carb high-fat diet, the sugars were the only thing threatening my overall cardiovascular health.

Yesterday I got my most recent blood test results, and while my cholesterol/triglyceride levels were flat, my friggin’ fasting glucose and A1c went up to 112 and 5.6 respectively. Needless to say, this was not the result I was looking for when I started IF in early September. In fact, while my doctor suggested I do IF five times per week I have been doing it virtually every day for three months.

Rather than panic and give up, I thought a little more about how I’ve been eating (and drinking) over the past three months and the truth is while I have generally been on a low carb high-fat diet, I have cheated a ton. It started with a 12-day vacation to London and Paris, where I ate more than my share of chocolate croissants, macarons, and muffins and drank more than my share of beer. When we got back from Europe, I continued to snack here and there on sugary cookies and muffins and continued to have a few beers every week. I went on a boys’ trip to Wyoming where in two days I drank more than I do in a typical month, went to a beer festival with my son, and then between Thanksgiving and Christmas I’ve sneaked an unhealthy amount of sugar-laden foods and drank plenty of beer. I also hurt my lower back, which still hurts by the way, and as a result, I have not exercised much at all.

Mmmm Beer.

All this is to say, I probably counteracted the good from the IF with the bad from my lack of dietary willpower. I sent my primary care doc a note to ask for her advice, and she said to continue with IF because it really takes closer to a year to see significant results on the A1c and sugar front. She suggested I try doing IF only five days per week, but to try to extend it a couple of days a week from 16 hours off to 18-20. On the diet front she told me to eat a diet that I will stick with.

Rather than freak out, I have decided to rededicate myself to eating a low carb high fat diet, get serious about cutting out the “holiday” snacking, do IF Monday through Friday, and increase my walking to 5-6 days per week or a minimum of 150 minutes per week as recommended by the American Heart Association and others. Honestly, I felt better physically when I was sticking to the low carb high-fat diet more religiously. And the more beer I drink, the worse my GI system feels. If I didn’t love beer so much I’d give it up completely, but for now, I suppose I’ll limit my intake of the nectar of the gods and only imbibe on special occasions.

The experiment continues!

So You Think Keto is Extreme? Hold My Beer!

Two weeks ago I went to my first appointment with a new primary care physician and she said that while my bloodwork looked pretty darn good, she thought my sugars were still a little higher than she’d like to see. For crying out loud, I’ve been eating like a champ and my other numbers are, frankly, enviable. Total cholesterol 108. LDLs 59. HDLs 41. Triglycerides 94.

But my glucose was at 106, a touch higher than the recommended 99. And then there’s my LP-IR Score of 56. Any doctors out there agree that glucose of 106 and LP-IR of 56 is a concern?

Then my new doctor said something that surprised me. “You should consider intermittent fasting,” she exclaimed.

Wait, what? Don’t eat? But…but…but.

She explained to me that there was a lot of research out there that intermittent fasting (IF) was the best way to lower insulin resistance and that many people found it easy to integrate into their diets. She suggested I try IF 4–5 days per week and after a while, we could recheck my insulin numbers. She also jotted down the name of a Canadian doctor who has written a few books about the subject, Dr. Jason Fung, and sent me on my way.

I’ll be honest, I’m a connoisseur of popular diets and eating styles but I’d never heard of IF. So I went home and searched the interwebs for details, and before long I was fully down the rabbit hole. Holy moly there is a whole subculture of people who don’t eat for long periods of time in the name of good health.

I watched a few interviews with Dr. Fung and I was really struck by the science. I downloaded one of his books, The Complete Guide to Fasting: Heal Your Body Through Intermittent, Alternate-Day, and Extended, and read it over the course of a few days. I went from thinking the idea was crazy, to deciding to try it out.

Fasting has been around for thousands of years, and for our ancestor’s fasting was simply a matter of the difficulty of sourcing food. Our paleo brethren often went long periods without eating and I suspect there weren’t too many cavemen with type 2 diabetes. Fasting has long been used in religious worship across multiple belief systems. Hell, when you think about it we all fast daily — we don’t eat while we sleep. Intermittent fasting is just increasing the time you already don’t eat. I decided to use the 16/8 method of fasting, where you don’t eat after dinner and then skip breakfast before breaking the fast at lunch. What that looks like for me is that I don’t eat from 7 p.m. to 11 a.m. (water, tea, and coffee are fine).

Without going into too much scientific detail, IF is about insulin. When you eat, your insulin increases. When you don’t eat, it doesn’t. If your insulin is always elevated because you eat all day, and/or eat too much sugar and carbs, your insulin remains elevated and your body reacts by pumping sugar into your bloodstream. When you are fasting your metabolism increases. The bottom line is your body burns off sugar to provide energy, and when it runs out of sugar it burns stored fat.

There’s a nice explanation of the benefits of IF at Healthline. There’s tons of information all over the web so if you want to learn more just Google it.

I’ve been doing IF for almost three weeks now. Truthfully, it’s not difficult. I just don’t eat after dinner and then skip breakfast. I start eating again around 11 a.m. and between lunch and dinner, I try not to snack too much. Of course, when I do eat I eat a low carb, low added sugar diet. I call it a modified Mediterranean Diet or Pegan (which I’ve written about before).

I won’t know if IF has lowered my insulin levels until I get them checked again in a few months, but I can tell you I have lost weight. Belly weight. My midsection is definitely tighter and my pants are looser. I mean, it’s not rocket science. I’ve been eating less. Is that a crazy idea? I don’t think it is.