Cliff, 56

Symptoms before diagnosis:  

Around my 50th birthday I was feeling permanently fatigued. One day I was coming up from the basement and I noticed I was out of breath at the top of the stairs. I told myself, okay, enough, I’ve got to get back in shape. I bought a “fat tire” bike and went riding in the snow. But with the exertion I experienced chest pain — angina. And I knew that was not good.  But because it was Christmas, I waited two weeks to see the doctor. (I know, not the responsible thing to do. )

Diagnosis and treatment

When I described the chest pain, I got sent off for tests right away. I hadn’t had any blood tests for about two years, so we didn’t catch my blood sugar rising earlier. I just skipped past the whole prediabetes warning stage. I got diagnosed with everything; Fatty liver [formerly known as Non-alcoholic Fatty Liver Disease, NAFLD and now by the new name metabolic dysfunction-associated steatotic liver disease, MASLD] type 2 diabetes, metabolic syndrome. And one of my coronary arteries was blocked on an angiogram.

What did you do?

I was in shock. The artery blockage was not severe enough for a stent. But I knew I had to take my health seriously. I knew that I had to make changes, especially to my diet. How I had been eating had not been that bad, compared to the standard American diet of ultra-processed foods. We have a couple of acres with chickens and a large vegetable garden  so I ate whole, unprocessed food. But I ate too many carbs and I overate portion sizes. Since my background is as a science researcher I turned the literature about diabetes remission. This was 2018. I could see that Direct Trial results were positive using very low calorie shakes. And the first results of the Virta Health Trials on the ketogenic diet for type 2 diabetes were coming out, and while not randomized, they were impressive.  I said “I am not doing the 800 calories shakes.”  So my wife and I decided to try to a low carb ketogenic diet like the Virta program.

What happened?

The ketogenic diet worked really well for us. We did it consistently for 18 months. We both lost weight. I lost 55 pounds, going from 275 pounds down to 220.  I reversed my NAFLD completely within a few months. That liver fat got burnt off first.  I then put my diabetes into remission. I used a CGM (continuous glucose monitor) for two years. My HBA1c got down to 5.0% at its lowest. I felt great.  My fatigue lifted. But when COVID happened, we slacked off a bit. We took our foot off the gas, as it were. We gained a bit more weight back. My blood glucose markers increased, but I am still in remission. Six months ago my HbA1c was 5.9%., so it has climbed up but has still remained out of the prediabetes and type 2 diabetes range. I have gained back about 13 pounds however. We are planning to get back on track and to become be a bit more strict again.

What are you doing now?

We still try to reduce all our carbohydrate sources to just vegetables and legumes. We started off in 2018 eating under 20 grams of carbs a day but now we are eating around 40 to 50 grams a day. We are still avoiding all ultra-processed foods. Generally, if it is in a package, with a nutrition label, we don’t eat it. I really enjoy the food, even if it is low carb,  so I need to be a bit more conscious of how much I am eating so I don’t overeat and to work in more exercise. I do like hiking, biking and I do a lot of yard work on our property. I haven’t had any more episodes of chest pain. But we are going to get a bit more focused again and continue the journey.

What is your favorite “go-to” meal?

I have so many! Beef tenderloin has to be at the top. But I have a smoker and I smoke my own salmon. We raise broiler chickens on our property so eating one of our own chickens is delicious.  We picked up a lot of Mexican low carb chicken recipes in our travels.  We have a big garden and we have a lot of kale and spinach, tomatoes, leeks. We grow asparagus. We grow a South African summer squash, called a gem squash that is delicious. I would say I like fresh food with flavor and spices.

What do you want others to know?

I think many more people need to know that dietary change, especially reducing carbs, is a viable option for diabetes remission. People need to have hope. That was why I volunteered to be one of the people with lived experience that consulted for the Diabetes Canada Guide on Diabetes Remission. But even if you have the awareness, having the motivation to change is essential. If you are not motivated to do it and stick with it, it won’t work.

Top tips?

Try to keep it easy and don’t stress. Eat more strictly at home, where you can have more control of the food. When I am out with friends or eating at their house, I eat what is served me. I don’t lecture people. I just eat good, whole foods. But feel free to skip meals if you are not hungry or the quality is poor. I skip meals on airplanes (my sons happily eat what I don’t.) Skipping a meal is not going to kill you.