I saw a lady in follow up yesterday that was a great addition to our growing list of successful “Real Patient Data” series. She is a 59 year old obese African American female with high blood pressure, diabetes, high cholesterol and sleep apnea. I’ve seen her for many years and she has really struggled controlling her diabetes. She actually ended up retiring a little early from her job over a year ago because she was finding it impossible to care for her diabetes and work at the same time. We ramped up her insulin for a while and eventually convinced her to go on an insulin pump that should have taken care of things.
After starting the pump we saw a great decrease in her Hemoglobin A1C which dropped from above 12 to10 and then to 9. The problem is that it got stuck on 9 and we have not been able to lower it much more. I increased the basal insulin pump rate several times, and it just did not have much influence. We reviewed her diet and she truly does not eat too much or too badly, but she continue to eat her “heart healthy” oatmeal and cereal for breakfast and other carbs that she has been told for years are good for her.
I have broached the subject of Paleo with her a few times, but she never really considered it. A month ago I saw her and she was convinced her numbers would be better because she had really stuck to her diet and not cheated at all. The good news for her is that her A1C dropped! Bad news is, it dropped from 9.01 to 9.00. Dejected does not touch where she stood at this point.
I talked to her again about Paleo and asked her what she had to lose? She is a little different than many patients in that she REALLY wants to control her diabetes, to the point that as I mentioned she retired early to be able to concentrate on doing so. We went over the entire thing again, I really took the time to explain WHY she could not eat the things Paleo restricts, and she finally realized what I already see…what she is doing is not working! She agreed to give it 30 days and on her way she went.
She came back yesterday and felt pretty good. When someone really tries to get better over time, and fails over and over, their confidence gets drained. She had no confidence that Paleo would work, so imagine her smile when I told her that after 32 days of Paleo, her Hemoglobin A1C had dropped from 9.00 to 7.45, and she had shed 9 pounds. I might add that we made NO adjustments to her insulin pump prior to starting Paleo, so this can be attributed to her diet as nothing else changed.
Several years of frustration corrected by a simple dietary change. Will she get off her pump? Absolutely not. Will she get her diabetes under control? I truly believe so as long as she can maintain her current diet. Will we be able to cut her insulin requirements? I hope so! This is a real lady, with a real problem, and real problems controlling it. She had tried hard the traditional way (heart healthy diet and more insulin) and gotten no where. I don’t think she’ll be going back to the traditional way any time soon!
I’ll also share a quick story about another patient I saw yesterday. I had spoken to him and his wife 3-4 months ago about Paleo, and they had agreed to give it a go. He is mid 50’s and healthy aside from his high blood pressure, diabetes, and the stroke he suffered around a year ago! They missed their 30 day follow up, so I figured they had not done the diet. As expected they came in and they did not mention it at all (figure they hoped I had forgotten!) We went over everything, and his numbers looked great. His blood pressure was perfect, his cholesterol was lower than treatment goals, and his Hemoglobin A1C was in the “non-diabetic” range. He smiled, looked at me and said “You see, I don’t need that crazy diet after all!”
That’s when I smiled and said “You are right, your numbers are perfect, and we can be happy with that. My problem is this…your numbers have been perfect for the 4 years I have taken care of you. They are always perfect…they were even perfect when you had your stroke! So are you ok with that, having perfect numbers and having a stroke?” He looked at me with a little smirk as if to say that I love when I’m right; and I do love when I’m right!
As we talked a little more I discovered that they had indeed taken some of my advice, and changed much of what they ate. He still ate cheese, but had been able to cut much of the carbs from his diet…just not all. As we looked at his numbers, we saw that even with these minor changes, we saw improvements in his A1C, Total Cholesterol, Triglycerides, HDL, and LDL. They are not what I have seen with strict Paleo, but they were something. I encouraged him to keep trying the best he could, and we would squeeze everything out of his dietary changes that we could. Take home message: In patient care, 50% improvement is better than no improvement!
I hope these patient experiences do two things for everyone. First, I hope they encourage all of you doing Paleo to keep doing it, and those considering it to give it a try (especially if you already suffer from chronic disease). Second, I hope it encourages you to talk to others and try to convince them to change their ways as well. What better gift to another than to help extend their quality of life and limit chronic disease!