Sarah – Patient Profile ‘Thin diabetic’

posted in: Diabetes, Health and Nutrition | 34

Dr. Jason Fung: I received a letter from reader Sarah, who has successfully used a Low Carbohydrate High Fat (LCHF) diet and Intermittent Fasting (IF) to reverse her type 2 diabetes. Interestingly, she is not particularly overweight as measured by Body Mass Index, yet still suffered from T2D. At her heaviest, she only had a BMI of 24.9, which puts her in the ‘normal’ range. She writes:

Sarah: I immigrated to US from China in the end of 1998 when I was 31 years old; I weighed about 55kg (121 lbs.). While I was in China, I lived thousands miles away from my family, so I had sort of intermittent fasting life style from age 19 to 31 years old.The meal was mostly vegetables and very little protein in China. I had annual physical every year but was never told of any abnormal blood result.

After immigrated to US, my life style suddenly changed from one meal per day to three meals consisted mainly grains with little fat and protein in U.S. I gained about 25 pounds in a couple of years my weight did not continue going up my heaviest weight is about 145 pounds. When I was diagnosed with diabetes in Dec 2004:

  • Weight: 142 pounds
  • Height: 5feet 4.3 inches
  • A1C: 9.4
  • FG:214

I was told to exercise, so I started Yoga shortly after my diagnoses. I lost about 10 pounds and 2 inches form my waist but still required metformin. In the spring of 2005 I relocated to Galveston from Houston in June 2005 because my work as an engineer. My endocrinologist measured my after meal glucose in her office, it was near 200 after 3 hours of my lunch which was only one low fat peta bread. I was devastated, my previous family Dr always told me that if I exercises daily, my blood sugar will come down to normal, so I believed him. I was doing my yoga every day, but I thought that would be enough.

I volunteered to Joslin Diabetes Center’s clinical research in July 2006, and traveled to Boston as a research subject. I had gained about 5 pounds after adding 5 mg of glyburide so I stopped. In Boston, I was told that I need to gain muscle and reduce body fat because my weight was 144.3 lb and my total body fat was 32.3% from DXA result.

After returning to Galveston from Boston, I started to add running and weights, and my weight reduced to 132 lb in a couple of months, and noticed my blood sugar would drop about 100 point (from 240 to 140) in 10 minutes on treadmill. So I keep running about 45 minutes for 5 times a week and doing weights about 20 minutes three time a week, and a couple of hours of yoga every week.

My weight would fluctuate from 132 lb in winter climb to 145 lb in summer my waist would fluctuate from 30 to 31 inches. I watched my carb intake according to American Diabetes Association food plan, and noticed I could never able to consume the carb recommendations without elevate my blood sugar to the roof. As matter of facts, my blood sugar will spike to about 100 points with ¼ of a slice of bread during lunch. I tested over and over, I could not explain. However, I corrected my after meal spikes with running on treadmill for 10 to 15 minutes every lunch.

In about 2nd quarter of 2009, I stated vegan diet which consisted mainly with grains, beans, vegetable only not even eggs or cheese, after watch PBS on one Saturday. Vegan diets supposed to reverse type II based on the vegan promoters. During this period, I noticed my triglycerides had been climb up from 85 to 228, and my thyroid statistics also going up. After I got my lab test from Jan 21 2011, I decided to end my low fat vegan experiment. I started my experiment with one problem, then I ended with more problems. I attended the vegan Dr’s presentation in Houston, and asked him about my triglycerides, he could not explain to me. Though vegan diet did not help me with my diabetes, but I learned valuable information about how to use food as a medicine to help me. I also learned with increase in carbs, my triglycerides will go up which is a bad sign for my heart.

In Feb 2011, I started to experiment with low fat vegetable diet, after about a year, all my coworker and my friends noticed my skin and palm turned into a green yellowish and my hands and feet are cold all the time with swelling. My face swelling every morning and my hands and feet swelling in the afternoon. I realized there is some wrong with my experimental food plan. I was told it is a degenerative disease so I accepted my fate. Continue with low fat vegetable almost no saturated fat diet. Internally, I experienced fatigue every day which I could not explain.

By Oct 2014, my A1C climbed to 7.9, I almost broke down in my endocrinologist’s office. He comforted me and said it is not a big deal, he sees patients with A1C 10 above every day. I am one of his good patients.

I knew the grains triggered my blood sugar spike, so I started eliminate all grains and beans from my diet completely, but I was still afraid of fat especially saturated fat. I bought Dr. Richard Berstein’s books, he stated rib-eye steak is better than the lean steak for diabetes. I was shocked. Fat would give me diarrhea since I was a little girl, so I have been avoid eating any saturated fat all my life. I grew up in food rationing era in China where almost no saturated fat is available from markets beside government stores.

So I started to understand the reasons such as the vegan would never worked for me. It was not dietary fat that caused me to be diabetic. I ate almost no fat my whole life. I added saturated fat such as beef, butter, and coconut oil to my diet, I found DietDoctor web site. Dr. Andreas’s experiments in a diabetes conference meal was very similar with my own experiments. With ketogenic diet, I was able to reduce my A1C from 7.9 (10/28/2014) to 5.9 (6/20/2015) in about 8 months. I kept my carb intake to about 20 grams which mainly came from vegetables. Oct 2015

April 2017

By August 2015, I discovered Dr. Fung through I have been practicing intermittent fasting ever since. By March 2016, my A1C was measured 5.6. I lost total about 12 lbs since I started ketogenic (Nov 2014) my waist is 28.5 inch, and weight 127 to 130 lbs through out a month period. I no longer have swelling on my face, hands, and ankles.

Since I started ketogenic diet, my blood sugar would surge during exercise by about 80 points. For example I would started at 110 before tennis, after 45 minutes my BG would 195. I tested over and over. I tried to use chocolate or cheese before exercising, none of which was able to lower or keep my blood sugar from surge. Out of desperation, I took a teaspoon of coconut oil then went on exercising, I found my blood sugar is remarkably stable during and after exercising.  Before I found the secret of coconut oil, I could not begin to walk my dogs with blood sugar at 90, because it would surge to near 200, now I can take a teaspoon of coconut oil, then go to do exercising without experience any blood sugar surge. I am no longer depressed being a diabetics.

Dr. Jason Fung: That’s amazing work, Sarah. With these detailed records, you can see how LCHF and IF help even with a so-called ‘thin’ diabetic. Asians tend to get type 2 diabetes at lower BMI than North Americans, with the average Chinese type 2 diabetic having only a BMI of 23.7 at diagnosis, not unlike Sarah. Even with a waist of 31 inches, you can have type 2 diabetes. The important factor here is the intraorganic deposition of fat (inside the liver and pancreas) rather than the total fat mass.

Nevertheless, the pathophysiology of ‘regular’ and ‘thin’ diabetes is similar, and responds equally well to dietary interventions. It’s striking that even 10 years of diabetes on medications can be reversed completely since an A1C of 5.6 without medications defines Sarah as non diabetic. Congratulations!

34 Responses

  1. Susan Guthrie

    My diabetic journey is very similar to Sarah’s. I was the same weight and height as Sarah. I am also Chinese. I found keto/IF and Dr. fung July 2016. I have been med free for 7 months now. I now weigh 110 lbs.

  2. Congratulations on your success. Typically we engineers have some skills that are useful with regard to health. My records go back to 2002. When I discovered Dr Fung, I was able to take advantage of his advice to improve my lipids and blood glucose completely informed with how I responded to the Atkins diet and other ways of eating in the past.

    My biggest challenge now is our family doctor is reluctant to do lipids since my annual results have been so good. Fortunately, I am also required to have an annual VA physical, so I get complete labs plus some from them.

    • Jim, find the Cholesterol code blog by Mr. Feldman (also an engineer). He also has a presentation on youtube at one of the low carb forums. He shows ways to change your cholesterol numbers in as little as 3 days. That in case you need to tweak your doctor’s opinion, or save a few bucks on life insurance.

    • It’s quite easy these days to bypass doctor and insurance company lab test limitations by scheduling a variety of tests directly. Lab Tests Online and Health Check are but two of these. All seem to provide basic interpretation of the results and quite reasonable pricing to fit individual interests and schedule.

      With cholesterol in mind I’d recently completed a full 7 day fast and scheduled a blood draw on the final day. While the numbers appeared seemingly negative at first glance, I’d realized that their standard baseline for comparison is averaged from a population that never fast, so what was likely revealed was my body’s operation in what should actually be considered normal biology for our evolutionary equivalent caveman ancestors.

      That blood sugar or LDL might appear high (even in the accompanying article) may merely reflect the fact these become the primary operating energy source. Other sources too (Volek/Phinney) have indicated that there’s a temporary spike in cholesterol numbers when otherwise unutilized fat becomes the primary energy source.

  3. Luciano

    Hi, great story Sarah.
    I would like to understand what happens in the body when BG goes up during/after exercise and in the case of Sarah, why does the spike not happen when she takes Coconut Oil?

    • Some hypotheses (note this comes with absolutely no guarantee: I’m just another engineer dabbing in metabolic mechanics 🙂 ):

      -Exercise causes secretion of adrenalin
      -T2D is characterized by insulin resistance, possibly due to excess glucose within the tissue (overflow/balloon/tokyo subway hypothesis)
      -If not even insulin is capable of shoving more glucose into tissues, much less will non-insulin related glucose transport occur
      -Adrenalin forces the pancreas to stop insulin secretion, and increases lipolisis and glycogenolysis in both liver and muscles (“priming the pump” for exercise)
      – So exercise will raise BG in order to keep the fuel coming, but tissue is already quite full, since it started from “overflowing with fuel” and muscular glycogen is being turned into glucose on top of that. Thus raised BG during exercise.

      Now, why would a mere teaspoon of coconut oil change all that?

      First, consider coconut oil is around 15% MCT oils, plus 50% lauric acid (which is “almost but not quite” MCT).
      MCTs get directly turned to ketones, lauric acid gets turned into ketones quite fast too (although passing through the liver).
      So a teaspoon of coconut oil may cause, in a LCHF dieter, a sort of instant, short-term ketosis.
      The liver reacts to ketosis by slowing down glycogenolisis (interprets glucose is scarce and must be saved), thus compensating for adrenalin and maintaining stable(r) BG levels during exercise

      …or then again, maybe not

      • sten bjorsell

        Carlos, your explanation makes sense. Maybe add cortisol secretion. Note that she did not say if this continued after she moved on to LCHF combined with IF and practised it for a few months.
        I think that the reaction, stalled by the oil in the way you explained, originates in a fatty liver, and other fatty organs like the pancreas. Once the fatty organs corrected, the diabetes is corrected and there should be no more need for MCT oil to prevent hig BG at exercise. Maybe Sarah can explain how it is now, with proper GBF, with BG during exercise with and without MCT-oil?

      • deirdra

        I wonder if the CO would work if she were not already eating LCHF and adapted to using ketones for energy, given how quickly it worked.
        What a sad fact that “the standard of care” told her to exercise like a hamster after each meal instead of not eating the foods that cause the BG spike in the first place.

      • Luciano

        Carlos, Thanks for your explanation. It’s helped me, non Engineer, make more sense of what is going on.

  4. HabeebuRahman

    Congrats Sarah.
    I am on LCHF for the last 7 months.
    I was diabetic for the last 11 years and was on highest dose of medication.
    I had very good results in BS. 178 to 106. But when I stopped sulfonylureas and kept only metformin, BS started rising and now it is 160. My fasting insulin came down from 3.9 to 2.3, but A1c improved from 8.4 to 6.8 . But since I have got rid of the hazardous sulfonylureas, I am hopeful of bringing down the BS within a few months.
    In brief, I can say that this is the only way to get rid of this otherwise chronic and progressive disease, if it is strictly followed.

  5. Great work Sarah ! Congratulation on your progress and new found peace of mind.

  6. Deborah Hart

    Thanks for sharing your experience and with data to back it up! I could never bring myself to go vegan and now I know it’s not the only or even best way to fix metabolic issues. Gurus like Dr. Fuhrman make it sound like it’s a cure-all.

  7. primalgranny

    Yes! Why does BG go up during and after exercise? Is this a problem with T2D?

  8. I believe the 18 month’s vegan diet experiment over stressed my pancreas. As you can see, my pancreas only produce 2 units of fasting insulin. Maybe vegan diet turn me into insulin deficient, that explains why I can not tolerate any starch food and my BG spike during exercises. I hope someone can explain the biology behind to me.

  9. Charlene

    Sarah– thank you for sharing your experience with LCHF & IF and Congratulations on reversing T2D.

  10. Good to hear someone defeating a chronic disease!

    I’m no diabetic but have been fasting on and off after reading Dr. Fung’s articles. Recent blood test showed my fasting glucose lowest ever! (74). But LDL is high at 155 & total cholesterol 212. I have to bring that down, hopefully same fasting will help. I didn’t really cut down too much on carb only fasting. Plus some coconut oil.

    • Just to clarify I’m 51, male Indian.

    • Raj: I read (but I have difficulty retaining info) that LDL has two parts and you don’t want to lower the good LDL. Medications lower all the LDL and that apparently is detrimental. You may want to research the LDL’s as like the type 2 D, there is an alternate school of thought that my physician and apparently many physicians have not reviewed. I am not confused with HDL.

  11. Krishna

    Raj how did you reach thr figure of 74 qa it an ecgended fast ?? and for how many days ??

  12. Krishna

    Raj was it an extended fast ?? and for how many days

    • No it was several short ones average 24 hr. Max was about 40+ couldn’t manage more although the issue was discipline not physical. Rest of days I eat normal

  13. Krishna

    Sarah Hi and Congrats
    I would like to know how many days you
    If you could you share your fasting schedule

  14. Hi Sarah, what an encouraging story. Well done. I am 68 yrs old, a retired MD. I now own and operate a cattle ranch in Australia. I consider myself to be “healthy”, have no aches or pains, take no medicine, exercise regularly. Don’t drink alcohol or smoke. Six days ago I voluntarily admitted myself to a clinic to do a supervised 10 day water only fast. My reason was to get rid of those extra kilos, do a detox and Get control over those sugar cravings. I am 182cm tall and weighed in at 107kg.To my shock I recorded a raised BP 170/100. Day one I had a small vegan lunch followed by a green salad. Early morning day 2 my fasting BG was 7 ( it should be 5 or less) So, now I know for sure I have the metabolic syndrome and am certainly at best prediabetic. While here, I discovered Dr Fung and all you guys. Really appreciate your input because, I like most of your family doctors, have had no training in nutrition and clearly am clueless on how to manage a raised insulin. LCHF makes so much sense as does IF. The really exciting part is I know this is totally reversable and I am in total control. Thanks agin to all of you.

  15. Krishna,

    I practice IF (one teaspoon of coconut oil before walking my dogs and with no dinners in most of weekdays) on weekly bases. My longest fast is about 36 hours to 48 hours only in a few weekends. I only eat one meal in most weekends. My FG got better as time goes by with IF in a range from 80 to 95 for last three weeks, my after meal glucose is about 110 or lower (with one table spoon of catchup on my meatloaf and vegetables). I understand from all my nutritional experiences, it would take time to see results. After about 6 months of IF, I started to see my fasting glucose coming down, now my FG is like twenty year old people according to Dr. Richard Bernstien. I could never thank Dr. Fung enough to speak about the benefits of IF, because every health professional always told me fasting is an bad idea which will cause damage of muscles, and diabetes should eat three meals or more a day.


  16. Hi Sarah, as one of those health professionals who has always considered fasting to be a bad idea for the reasons you suggest, I am embarrassed by my ignorance.. If I am honest, I was just following the party line and never took the time to try and understand the metabolic changes. Clearly I had no understanding that a raised insulin is the culprit. It’s more embarrassing when one considers that 50% of the population probably suffers from the metabolic syndrome. T2D, Heart disease and cancer are well recognised consequences. I suspect +70% of patients attending their doctors rooms are on this continuum. As Dr Fung says, it’s so obvious once I had changed my paradigm. This has been my first ever fast. I am staggered at how rapidly the body can recover when you address the root cause. I look forward to a healthy LCHF/IF future. Be assured I will do my best to educate my colleagues. I am no longer in practice so cannot implement this understanding. Thank you, most sincerely, Dr Fung for helping me. To all of you who like me, are beneficiaries of the “Fung Insights” on behalf of my colleagues, please accept my apology.

    • Hi Paddy, one of many reasons to use my body as a lab rat is I was confused with all the conflict information about how to treat diabetes, and I did not know which hypothesis is right for my condition. So, I started to learn and to do countless blood glucose measurements on each food before and after I eat. I figured out which food raises my BG, but I could not lower my FG until I found Dr. Fung’s lectures. I would never believe if I did not try fasting which have this tremendous health benefits on my health. I no longer experiencing daily fatigue in the morning since FG drop to below 95. What happen to me with fasting is amazing, that is why I wanted to share my story with people who may suffer a similar chronical condition.

  17. Hi Sarah, we are all so grateful to you for sharing your story accompanied by such detailed notes. You will help millions of people Just by reading your case history. Once people understand that T2D is fully reversible by something as simple as LCHF and IF they will commence on a journey of truth. Dr Fungs lectures are brilliant and freely available to the world. I hope you are very proud of your achievement. Thank you again. You are a true champion.

  18. Krishna

    I was diagnosed with a random BG of 500 and Hb1ac of 12 % in May 2011
    I was admitted to hospital and and was given intravenous insulin for 3 days got released on the fourth day with insulin injections and 3 different meds
    started walks for 11/2 hour and diet control basically less carbs and following this and Homeopathic treatment in India
    i came to a single tab of Metformin 500 SR and by May 2013 i was down to an A1c of 5.7%
    I became quite careless with my diet again from the end of 2015 and the A1c is back there at 7.3 % again hitting an FBG of 201
    I started IF and LCHF on April 24 2017 and my FBG is down to 105 to 110 i have lost 5 kg too but i want to go down to FBG
    85 TO 90
    C PEPTIDE — 3.41 Fasting Insulin-15 PP Insulin -56

    does anyone think coconut oil will help ??

  19. Sarah! Amazing work!

    What was your fasting protocol? How many days per fast? How often?

  20. My A1c is 5.7 but my fasting blood glucose is regularly 90-109. I have been doing intermittent fasting for about 8 months, omitting dinner. I have been on a low carb/ mostly gluten free diet for almost a year and went to carb free, other than the little bit I get from non-starchy vegetablesalmost 3 months ago. No artificial sweeteners or sugar substitutes or “healthier” alternatives for almost 3 months. I consume about 1 tablespoon of coconut oil at each meal. I snack on walnuts (was almonds until 3weeks ago). I drink raw vegetable juices, make everything from scratch, eat fermented veggies, grass fed/finished beef, no dairy for 3 month. A year ago my cortisol was 14. Could the cortisol be the problem?? If so, how do I get this down?? I have begun meditating, tapping, positive affirmations, slowed down, consciously seek to live a calm, relaxed life, have begun telling people “no” and am working to heal leaky gut. How do I get fasting BG down??

  21. Also, I have lost 15 lbs in the last 6 months. I am not over weight, I am 6 ft tall and weigh 145 now.

  22. This is a very interesting and informative conversation. And Sarah’s information adds greatly to the information on metabolic syndrome. I thought I’d share my experience to add to the picture since we’re all trying to learn how we can affect our health. Ten years ago I went whole food plant based (WFPB) to reverse my 30lbs overweight, prediabetic (fasting glucose 125), gout, That has all resolved and my BMI is now 21.3. However, I, too, noticed an increase in my triglycerides as did Sarah when she went vegan. While I was never diagnosed with either diabetes or prediabetes I could see that, originally, I was headed in that direction before my diet change to WFPB. While I remain WFPB vegan, I, like Sarah, chose to adjust my diet by going low carb vegan. I did not go high fat by eating coconut oil. While I did not originally (10 years ago) get my A1c tested, I did test it one year ago resulting in a 5.4 A1c which I was quite fine with. However, my triglycerides were slightly above the upper 150 normal range and I wanted to address that. Hence my switch to low carb. For me that meant eliminating bread and severely reducing/eliminating most grains. I have a physically active job so I can burn off energy I take in in the form of carbs. However, my carbs are not normally in the form of grains but in the form of vegetables such as potatoes, winter squash, or other starchy vegetables. However, I consume them in the morning and never past lunch so as to give my body opportunity to burn off calories. I eat an early dinner of green vegetables, always a very large salad of leafy greens or cooked greens. Since I would rather not eat animal products for other health reasons I find it easy to consume a small amount of concentrated vegetable protein such as seitan or tempeh or edamame (which is soybean). Whole fresh soybeans are about 40% fat, 30% protein and the rest carb. Or I may choose nuts instead. I also, like Sarah, built into my day a period of fasting. After my early evening meal of green vegetables (and there are numerous ways to prepare them so that they are flavorful and enjoyable), I don’t eat again until a minimum of 12 hrs has passed. If I am still not hungry at the 12 hr mark, I continue to fast until I feel a genuine hunger. This way I build in a daily period of fasting. On a weekend the fast may extend much longer if my schedule and activities allow it. Long story short, my recent blood work showed a fasting blood glucose of 89 and my A1c dropped to 4.9. Over the years of WFPB low carb eating my BP went from 120/80 to its present day 105/65.
    I offer my experience because I think what we’re seeing overall is that our modern society offers us many opportunities to over consume calories which our more sedentary lifestyle does not allow us to burn off. Fasting is a way to give the body an opportunity to get rid of excess internal fat and calories.
    Another interesting piece of information I learned about more recently is the benefits of high intensity interval training. To the point – HIIT stimulates the body to create more mitochondria within the muscle cell (mitochondria are the energy producers inside each cell and burn calories). As we age, our mitochondria reduce. HIIT increases the numbers of mitochondria and has been shown to assist in burning off more calories. Other typical exercise modalities like weight training (which builds muscle), running, bicycling, etc. do not result in increases in mitochondrial formation within the muscle cell, interestingly. Only HIIT is shown to do that. One can google HIIT for more information on this topic.
    The last thing I’d like to mention is that it is not lost on me that when the beef industry wants to fatten up its beef right before slaughter, the cows are fed corn, . . a grain. It is the “finishing” on corn that creates the fatty marbling in the meat which softens and tenderizes the meat which the public finds so desirable. Cows in pens (no exercise) fed corn (grain) fattens them up. The same thing happens to us if we are sedentary and consume high concentrated energy grains – just a thought.

  23. Jeanmarie

    Wow, what an amazing story! I wish all the vegans and low-fat advocates could read Sarah’s story.

  24. Krishna

    Very encouraging to see all these sucess stories !!
    Another question that i had is that do people see an improvement in their PP readings too with improvement in insulin resistance or is it that glucose peaks up the same way and comes down faster than usual after the insulin resistance has reduced !!

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