5 lessons from Peter Attia to Master Diabetes
No book so far has crystallised the importance of metabolic health for longevity and long term health as Peter Attia has done with his book Outlive.
By the time I reached the end of the book, I had a completely new and superior understanding of how much more I should do to “get the metabolic house in order”, if I am to improve the quality of my life in the long term.
As type 1 diabetics, metabolic dysfunctions are a daily business: with a pancreas that does not produce any insulin, we are the ones in charge of making sure that our blood glucose stays within the ideal range.
To achieve that, we must minimise insulin resistance - the condition that makes your body unable to make efficient use of insulin to process and store glucose for energy - and that entails very conscious decisions about what we eat, how much we eat, how active we are, and so on.
There are 5 points I took from this book that gravitate around improving metabolic health (and type 1 diabetes) and that I am now implementing in my own life. Here they are.
1) Aerobic Exercise: An Essential Brick In Your Type 1 Diabetes Mastery Strategy
Aerobic exercise simply makes you more insulin sensitive (the opposite of insulin resistant).
Why? Because when we engage in longer bouts of exercise at a moderate intensity, like a slow run, rucking, or biking - in other words, that intensity that allows you to have a conversation, but you’d rather not have it - we become more efficient at utilising glucose and fat as fuel.
During slower but longer aerobic workouts we burn primarily fat, and after a while we reach a point where we tap into our glucose reserves and burn what’s in there.
We’re also improving the health of our mitochondria, which helps to keep the fat accumulation under control. Insulin resistance will force your body to rely primarily on glucose as a source of energy, so if you’re Insulin resistant you’ll burn glucose even in zone 2, instead of fat, so the fat that you’d need to burn will stay there.
But the more our mitochondrial “engine” improves, and we improve it a great deal with aerobic training, the greater effort we can sustain within the zone 2 boundaries, and the more we regain our ability to burn fat efficiently.
Insulin resistance will put our mitochondria under severe stress and impede its most efficient work, which means that an insulin resistant individual - already prone to fat accumulation - will be unable to burn fat due to inefficient mitochondria. Chronic fat accumulation raises our blood glucose levels, which “damage organs from our heart to our brain to our kidneys and nearly everything in between”.
Take home message: Zone 2 training is our best way to improve the health of our mitochondria, to bypass insulin resistance and regulate our blood glucose levels, bringing them closer to the ideal range.
I see that happening in my own body: my long runs do wanders to the stability of my blood glucose, both during and after the workout. And on a longer time span, since I turned running into my main type of physical activity, I notice a great difference in my ability to manage my blood glucose.
Key Takeaway: Engaging in aerobic exercise, especially Zone 2 training, can enhance insulin sensitivity, improve mitochondrial health, and help burn fat efficiently, making it a crucial component of managing type 1 diabetes and metabolic health.
Here's what I'll do: I already incorporate plenty of Zone 2 aerobic training into my fitness routine (I run a lot). I will start incorporating short bursts of VO2 Max training too!
2) Time of meals is crucial to maintain stable blood glucose
Another thing I have noticed is that it is much easier for me to keep blood glucose in range earlier in the day than later in the day.
This anecdotal evidence of mine was confirmed in the book, and in hindsight it makes sense: in general, we’re much more active in the morning and in the afternoon than during the evening, and all that activity - even just walking to the office or at the grocery store - will help burning out the energy we consume, improving our insulin sensitivity.
Personally, I require nearly half as much insulin for a my breakfast than I do for my dinner. I tried eating the same meal (a big bowl full of fruit, around 200 grams of carbohydrates) at the beginning and at the end of the day, and the difference was substantial: in the morning my blood glucose would simply stay in range for hours, while in the evening I would often have to inject some extra units in the hour after the meal and at times witness my blood glucose spike overnight.
I am thus eating the bulk of my calories earlier in the day, between breakfast and lunch. Pizzas and other large dinners - the ones you get at parties, when “it’s been a long day and I deserve it” belong to the past. My long term health is much more important than those unhealthy treats!
By the way, if you often experience overnight spikes in blood glucose, that - elevated fasting blood glucose - could be a signal that you are insulin resistant. We can fix that with a nutrition strategy that promotes insulin sensitivity.
Key Takeaway: Eating meals earlier in the day can help maintain stable blood glucose levels due to increased daily activity, and adjusting the timing of meals can be an effective strategy for managing diabetes and insulin resistance.
Here's what I'll do: I will shift my calorie intake towards earlier in the day to take advantage of increased activity levels and reduce the need for insulin later in the day. I won’t go back to intermittent fasting, I’ll simply make my last meal of the day lighter, such as a big salad with a small portion of some grains.
3) Whole Foods, Plant Based, Low Fats to Master Diabetes
While Dr. Attia does not advocate for one diet or the other, he does advocate for a way of eating that is sustainable long term and that keeps us away from metabolic syndrome. That is: stay away from processed stuff and eat foods that are as close as possible to the way they are in nature.
He also does not advocate for a low fat diet. In fact, when it comes to diet, he lists “a few basic rules: don’t eat too many calories, or too few; consume sufficient protein and essential fats; obtain the vitamins and minerals you need; and avoid pathogens like E. coli and toxins like mercury or lead”.
In my case, I make sure I meet my protein target of 100-150 grams per day (given my weight and activity level), and that I get sufficient fats, especially in the form of omega-3 fatty acid.
Then, my main focus is on good, clean, whole sources of carbohydrates rich in minerals and nutrients (fruit, to name one!). It may sound paradoxical, but since I started consuming 70% (at times 80%) of my calories from carbohydrates, 20% from protein and 10% from fats, my insulin requirements have dropped tremendously while my carbs intake has nearly doubles (within 500 and 700 grams per day).
All of that without accumulating fat nor weight nor to the detriment of my energy levels.
That is direct consequence of an insulin sensitive body and is possible thanks to a lower presence of fats (more on that later). Because insulin is able to work efficiently, there are less spikes and less blood sugar roller coasters, the ones that determine energy crashes (in everyone, even in people without diabetes).
Peaks in blood glucose are a consequence of ultra processed foods, often deprived of fiber, that send glucose directly into your blood. Fiber helps tame the rise, but when fiber is not there (as in white bread or white pastas and those kinds of things), the short term impact on blood glucose is much more dramatic, and the long term consequences of insulin resistance compound.
Following the Mastering Diabetes approach, I eat green light foods that are whole, rich in carbohydrates and naturally low in fats. I fuel greatly for my runs and recover even better. I feel great during the day and I have no troubles maintaining my ideal body weight and avoiding insulin resistance.
It might be different from your approach, but nearly two years in and a “90% Time in range challenge” completed, I can now swear by this method, which doesn’t clash with Dr. Attia’s broad guidelines on nutrition.
Most importantly, if you’re not persuaded by the whole food plant based thing, let’s not argue about diet. Let’s just go out and exercise, a far more powerful ally in fighting insulin resistance and metabolic syndrome!
Key Takeaway: Adopting a whole foods, plant-based, low-fat diet can help manage diabetes and improve insulin sensitivity, leading to better blood glucose control and overall health. If you’re not persuaded by diet arguments, know that exercising is more important.
Here's what I'll do: I will continue consuming whole, plant-based foods while keeping my fat intake low to promote insulin sensitivity and maintain healthy blood glucose levels. I will make it a point to not give in to the cravings that often screw up my blood glucose levels (dates, hummus, bread…foods I cannot consume in moderation). I will also strictly rely on the list of Green Light foods provided by the Mastering Diabetes Method guidelines.
4) Too Much Fructose is Bad: But What Fructose?
Fruit is good for diabetics. Fruit is the magic ingredient that will give you energy, replenish you of minerals and micronutrients, of carbohydrates and of fibers. If that was not enough, it will also stabilise your blood glucose and help you reverse insulin resistance. What a bang for your buck!
BUT.
You must keep your overall fat intake low. As mentioned earlier, this is key to keep your insulin resistance in check. Excess fats are a primary cause of insulin resistance: limit yourself to the essential fats that are necessary for your brain and for your body to function at their best, and don’t exceed that limit. I find that an overall 30 grams of daily fats (mainly flax seeds and nuts, sometimes tahini and very rarely oils and olives) are more than enough for me.
You must consume whole fruits. As a species, we evolved to store fructose as fat to survive long winters where food was less readily accessible. Now we’re constantly flooded with occasions to up our fructose intake way above what our body evolved to handle. Never in our history a species did we have fruit juices, fruit yogurts and other processed forms of fructose. All that extra energy must be stored somewhere, and that’s how you suddenly accumulate fat. Furthermore, being processed foods, they spike blood glucose and up your insulin needs, making you de facto insulin resistant.
Once your fat intake is under control, your blood glucose will stay in range no matter how much fruit you eat. That’s why I consume plenty of whole fruits!
Key Takeaway: Consuming whole fruits is beneficial for diabetics, but it's essential to limit overall fat intake and choose whole fruits over processed forms to avoid insulin resistance and excessive fructose consumption.
Here's what I'll do: I will continue enjoying plenty of whole fruits in my diet.
5) Take care of your metabolic health proactively
There are plenty of lessons to be learned from this book, and if you made it this far I highly suggest that you pick it up and read it.
Dr. Attia covers many other areas - and much more in depth, needless to say - that impact our healthspan even more than our lifespan.
In this post, I preferred to focus on metabolic health and insulin resistance because it is just so much impactful and because as a type one diabetic that is one aspect I have to deal with every single day and with my every action.
Should you read the book, you’ll learn that exercise (strength training, grip strength, Zone 2 training, VO2 max, proprioception and stability) is the single biggest lever you can pull to improve the quality of your remaining years on this planet.
You’ll also see that emotional health is arguably the most neglected and yet the most important element you should consider: what is the point of living longer and healthier, if your social life is miserable and are unable to share valuable moments with others?
But metabolic dysfunction and insulin resistance are truly dear to my hearth because they are one aspect I have laser focus on at every second.
They are so essential for long term health that it would be very stupid of me to dedicate to them any less time and effort than I am currently doing. Counting my macros, calculating my carbs-to-insulin ratio at every meal, adjusting the dosages according to the type and amount of food I am eating…it’s tedious, it requires discipline and some time.
But that is the whole point of medicine 3.0: you can’t expect a magic pill to come down from the sky and fix all your problems. You can’t wait for your doctor to tell you “Yes you’ve this and that problem, and here’s the perfect medicine for the fix”. It would be nice, but life is more complicated than that. You have to take responsibility.
You’re the patient and you’re the one in charge for the cure.
Key Takeaway: Taking proactive steps to improve metabolic health and manage insulin resistance is crucial for long-term well-being, and it requires personal responsibility and dedication to maintain a healthy lifestyle.
Here's what I'll do: I will take full responsibility for my metabolic health by diligently managing my diet, exercise, and insulin dosages to ensure a healthier and more vibrant future. I have already listed a couple tools I use for the job!
See you next week!
