What next,

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Shi Ona

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Relationship to Diabetes
Type 2
I was diagnosed type2 early march Hba1c 94 so did low carb / keto diet lost 4 stone and today was told I had reversed the diabetes, Hba1c now 40 but my cholesterol is high, so would now appreciate any advice on how to keep weight off and lower cholesterol, as my previous diet included a lot of dairy, and say fats. I am really nervous about eating carbs again.
 
Hi and welcome

Firstly congratulations on your amazing weight loss and HbA1c reduction. That really is an incredible achievement.
As regards the cholesterol, how high is it and has it increased whilst on the keto diet and do you know the break down of the different lipids ie HDL Trigycerides and LDL?
Many doctors just look at the total and if it is over 4 and you are diabetic (even in remission) they consider it too high and want to put you on statins, rather than looking at all the information including your personal risk factors. So I think first off I would want to be sure that there was something of concern that needed addressing.

As regards eating more carbs, Keto is pretty restrictive. Many of us here follow a low carb way of eating but don't go as low as keto and that is enough to manage our diabetes. Home testing with a BG meter is key to seeing how your body is responding to foods and working out how many carbs you can actually get away with. Have you been BG testing whilst doing keto?
 
Thanks for the quick reply, I need to speak to my GP again as she didn't give me the numbers today and was too excited at sorting the diabetes to ask, it was 5.5 when I was diagnosed in March and thanks for the info about two sets of numbers , I will check that out. I did the full keto for 3 months then went to about 30g carbs a day. But I have been eating a lot of creme fraiche, cheese, bacon fatty meats etc along with loads of green veg so just trying to get my head round cutting these out and finding healthier tasty things to eat instead.
 
Shi Ona said:
Thanks for the quick reply, I need to speak to my GP again as she didn't give me the numbers today and was too excited at sorting the diabetes to ask, it was 5.5 when I was diagnosed in March and thanks for the info about two sets of numbers , I will check that out. I did the full keto for 3 months then went to about 30g carbs a day. But I have been eating a lot of creme fraiche, cheese, bacon fatty meats etc along with loads of green veg so just trying to get my head round cutting these out and finding healthier tasty things to eat instead.
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Re BG monitor, I have been using it when I have been " naughty" but that is for the very rare occasions I had an ice cream. Will start checking how do with a slice of toast or some tatties
 
Shi Ona said:
I was diagnosed type2 early march Hba1c 94 so did low carb / keto diet lost 4 stone and today was told I had reversed the diabetes, Hba1c now 40 but my cholesterol is high, so would now appreciate any advice on how to keep weight off and lower cholesterol, as my previous diet included a lot of dairy, and say fats. I am really nervous about eating carbs again.
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Congratulations on establishing good control of your Type 2. But yes , 'What next?' A change of diet and lifestyle you can maintain long term. You probably can't continue on Keto or extreme low carb. What about moving up to 130 grams of carb a day ? If it maintains your 40 HbA1c all well and good. If it doesn't then perhaps walk up through the quantity and quality of medication until you have control around your 40 level.
And there's the exercise aspect as well that needs to be considered. It used to be said that Type 2s should have a two mile walk a day or equivalent exercise. Prof Taylor of the Newcastle Crash Diet suggests up to 15000 steps a day !
I don't think they should have told you that you have 'reversed' your diabetes. It's an inappropriate term in relation to Type 2 diabetes imo. The fundamentals of your condition haven't changed and a lifetime of management of it lies ahead as you clearly know.
 
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@Shi Ona If you had good results eating 30 gm of carbs a day, then I'd be rather surprised if increasing your intake to 130 gm a day did not undo a lot of the improvements in a very short time. I'd advise that you try adding a small amount of carbs - from berries, fresh veges, as many different plants as possible, but keep checking your blood glucose levels don't start to creep up - and your weight as well.
I have been in remission for quite some time now and still do not eat over 40 gm of carbs a day - not so much for my blood glucose control as for my weight. I don't weigh myself, but my waist expands rapidly and very easily.
 
Thanks for this advice, GP said to try small portions of potatoes etc, I too really want to keep the weight off as feel so much better, feel like I am 30 not 60 yrs old now. Going to substitute the butter for a plant based spread and ditch the pork scratchings I fell in love with! Also try to stay off hard cheeses, can anyone think of anything else where low carb eating clashes with low cholesterol eating?
 
Shi Ona said:
Thanks for this advice, GP said to try small portions of potatoes etc, I too really want to keep the weight off as feel so much better, feel like I am 30 not 60 yrs old now. Going to substitute the butter for a plant based spread and ditch the pork scratchings I fell in love with! Also try to stay off hard cheeses, can anyone think of anything else where low carb eating clashes with low cholesterol eating?
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Personally I eat and enjoy all those things (pork scratchings are my guilty pleasure too) and my cholesterol levels are slowly reducing. The current thinking is that cholesterol is manufactured by the body rather than transferring from your food, so giving up those foods may not help, but you can always give it a go and revert back if you see no improvement.
 
Ask for a proper breakdown of your cholesterol (HDL, LDL, ratio, etc) first so you know where you are. It’s saturated fat that raises cholesterol so you could concentrate on reducing that.
 
Inka said:
Ask for a proper breakdown of your cholesterol (HDL, LDL, ratio, etc) first so you know where you are. It’s saturated fat that raises cholesterol so you could concentrate on reducing that.
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There are a number of studies around now that say sat fat isn’t to blame, but carbs can raise chol. However, cholesterol isn’t poison. It’s a natural substance produced by the body which is needed a s a building block for every cell in the body and most particularly the brain. It starts to block arteries when it builds up to plaster over damage caused by inflammation in the walls of the arteries. Inflammation can be caused by high blood glucose as the glucose molecules attached to the blood cells can abrade the surface of the arteries, but cholesterol is not a “bad thing” per se and it much depends on it’s make up. So a total chol number is irrelevant.
 
A total cholesterol number is irrelevant? Yes, I agree - which is why I suggested the OP asked for a breakdown…

There are studies that show saturated fat does raise cholesterol. I appreciate the issue is complicated but as the OP has just had a cholesterol test, experimenting with some changes would be instructive because they could see the effect on their next cholesterol test. This is what I did. My total cholesterol was over the magic 4 but I wasn’t concerned nor was my GP. However, I did wonder if I could lower it or if it was just ‘set’ that way for me as an individual. So, I kept my diet the same but reduced sat fats. I’ve just had a cholesterol test and it’s dropped 0.4. So it seems my dietary changes have had an effect. This might not work for everyone but it’s an option to try.
 
Inka said:
A total cholesterol number is irrelevant? Yes, I agree - which is why I suggested the OP asked for a breakdown…

There are studies that show saturated fat does raise cholesterol. I appreciate the issue is complicated but as the OP has just had a cholesterol test, experimenting with some changes would be instructive because they could see the effect on their next cholesterol test. This is what I did. My total cholesterol was over the magic 4 but I wasn’t concerned nor was my GP. However, I did wonder if I could lower it or if it was just ‘set’ that way for me as an individual. So, I kept my diet the same but reduced sat fats. I’ve just had a cholesterol test and it’s dropped 0.4. So it seems my dietary changes have had an effect. This might not work for everyone but it’s an option to try.
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Yes indeed, you must know the breakdown as I also suggested, sorry I missed your first sentence. I think in actual fact that diet doesn't play as much of a role in cholesterol levels as has been previously thought. Mine can vary between 5.4 and 6.2 without changing anything in my diet.
 
I think people’s reaction is individual @Pattidevans That’s why it’s worth experimenting with ways of eating to find what works (or doesn’t work). I agree that other factors affect cholesterol level and that it isn’t mainly down to diet, but personally I was very pleased to see a reduction. It was gratifying to see that my changes had a result. My ratio also improved. It was good already, but still, seeing an improvement made me happy - like I had some control over things. It’s also encouraged me to continue with my amended diet.
 
Pattidevans said:
There are a number of studies around now that say sat fat isn’t to blame, but carbs can raise chol. However, cholesterol isn’t poison. It’s a natural substance produced by the body which is needed a s a building block for every cell in the body and most particularly the brain. It starts to block arteries when it builds up to plaster over damage caused by inflammation in the walls of the arteries. Inflammation can be caused by high blood glucose as the glucose molecules attached to the blood cells can abrade the surface of the arteries, but cholesterol is not a “bad thing” per se and it much depends on it’s make up. So a total chol number is irrelevant.
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Organisations which disagree with statements like "sat fats don't raise LDL, only carbs do", "LDL doesn't cause atherosclerosis", "inflammation is the actual culprit" etc etc etc include the European Society of Cardiology, the European Atherosclerosis Society, the American Heart Association, the American College of Cardiology, NICE. Basically, every single credible expert organisation on the planet.

 
Breakdown more important as said already.

Know nowt about keto diet, what do know is cardiovascular health is one of most studied subjects, so if looking for advice on cholesterol look at reputable sources for advice & ignore the quackery thats out there on web.
 
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