And yes I went to a cardiologist to do Echo scan and the results were amazing as per him saying continue whatever diet you are following and did not suggest any medicine.

Congrats for taking proactive steps to reverse your prediabetes. You may not need to be low-carb or strictly eliminate all grains, however. What I recommend in general is to understand WHY you became glucose intolerant, and then working to reverse that. Unless they made you overeat calories and gain weight, carbs per se may not have been the cause of your glucose intolerance: kzbin.info/www/bejne/kJS5lqGLl9amj7ssi=8y9XK2aK4ugtxnYy Of course, cutting out carbs in the form of added sugar and syrups, soda, ultra-processed foods, and refined grains is a very good idea, but you may be able to have all the carbs you like as long as they come from unprocessed or minimally processed foods such as legumes, whole grains, starchy vegetables, fruit and berries. I understand you were able to reverse your prediabetes, but you may still be insulin resistant to some degree. If you are curious about insulin resistance and what may have caused your glucose intolerance, here is the list of videos I usually recommend, in this order. To fully understand how the body regulates blood glucose levels and glucose tolerance, and what goes wrong in this process when we develop prediabetes or diabetes: Regulation of Blood Sugar: kzbin.info/www/bejne/j5iccoZoqMuMb7ssi=_0eoEnwxEJ1ZBttj The first step is to figure out whether we are insulin resistant: Measuring Insulin Resistance: kzbin.info/www/bejne/hYvXqaKaprR1mNksi=C681vsKNjXqWJSMq If we are insulin resistant, then the next step would be to think through the most common causes of insulin resistance to identify potential reasons for OUR insulin resistance: Causes of Insulin Resistance: The Personal Fat Threshold: kzbin.info/www/bejne/mYGYaKKDbdF1l7csi=eK6OeDRpGNpPzOqW Insulin Resistance: Top Causes & Contributing Factors: kzbin.info/www/bejne/forXn5-IeNZradUsi=kfHudBNBlFN1NlzU To understand why insulin resistance is damaging to long-term health: Insulin Resistance Syndrome: A Neglected Risk Factor for Chronic Disease: kzbin.info/www/bejne/fJiWn2Csnpenabssi=Cob6H4vwk6yCz12F Wearing a CGM can also be useful to identify early signs of glucose intolerance and insulin resistance: The Complete Guide to Understanding Your CGM Data: kzbin.info/www/bejne/eoexdWxmq7Zjrqssi=vpLTb-bAIvenYWjB As you write, for many people it is difficult to maintain extreme diets indefinitely. What I try to convey is that it is important to find a diet and lifestyle that we can HAPPILY live with forever, because only then are we likely to maintain its benefits. Best, Mario

Haven't recently researched that, but have made a note to make a video about it. You are not the first to ask.

Yes, with any change you make, such as implementing TRE or eating more protein or drinking less soda/alcohol, the amount of calories we need to feel comfortably full will be slightly reduced, and will help you find a new, lower maintenance body weight. To lower it further from there, you would need to incorporate new strategies that can help you eat fewer calories and be happy with that. See the playlist 'Keys to a Healthy Body Weight' for suggestions: kzbin.info/aero/PLIMWy92HkBVZbTYo6O-fm1r22GPW8BvNY&si=L636tPWUHyOd-INj

If that's easier for you, then that can be a great option. It is my experience that going low-carb is not easy for most people long-term, and that is also shown by the randomized controlled trials in this area. Long-term adherence to low-carb or ketogenic diets is poor in these studies. Therefore, it is my opinion that it is better to give people options, and using these strategies will certainly be better than not using them. They will also move diet and lifestyle in the right direction, and after taking those first few steps, maybe some people are then interested and willing to dig deeper and make more substantial changes. Best, Mario

oh this video kind of answered my question: kzbin.info/www/bejne/kJS5lqGLl9amj7s

Low-carb or keto diets can be very helpful in people with glucose intolerance, for two reasons: First, reducing the glycemic load of the diet makes a lot of sense in people who have issues with their glucose homeostasis in that eating fewer carbs puts less pressure on a dysfunctional system. So, for one, low carb and keto diets improve glycemic control (=lower the average and peak blood sugar level). Second, low-carb and keto diets commonly help people lose weight. And if excess body weight, specifically excess visceral and ectopic fat, are causes of the persons insulin resistance and glucose intolerance, then this should help improve both insulin sensitivity and glucose tolerance. As I explain in the separate video you linked, independent of changes in body weight, insulin sensitivity does not seem to be generally affected by changes in the ratio of carbs and fat in the diet. If anything, acutely (I.e., immediately after a meal), a high-fat meal does induce mild insulin resistance in response to the higher dietary fat. Of course, that is less relevant if the person is eating fewer carbs, and in the fasting state, insulin sensitivity is about the same in people eating low-carb or high-carb diets as long as they are weight stable. Phrased differently, the cumulative evidence does not support the claim that carbs per se cause insulin resistance and glucose intolerance, and that low-carb diets reverse this. Carbs, of course, are highly glycemic, which is problematic in people with glucose intolerance. And diets rich in certain carbs (added sugars and syrups, soda, carbs in ultra-processed foods, refined grains) can leads to overconsumption of calories and weight gain, which can then trigger insulin resistance if it increases ectopic and visceral fat mass. At the same time, I see no evidence that high-carb diets rich in whole foods such as legumes, starchy veggies, fruit and berries lead to weight gain, insulin resistance, or glucose intolerance.

Of course, eating lots of carbs in the form of added sugars and syrups, refined grains, soda, or ultra-processed foods is not recommended by anyone, for good reason. However, the available data suggest fairly strongly that their impact on glucose tolerance is through increased body weight and fat mass and particularly excess visceral and ectopic fat. Ectopic fat, such as in the liver, accumulates mostly when we can no longer store our excess fat in our subcutaneous fat tissue (i.e., once we have passed our personal fat threshold). We can also develop an increased fat content in the liver if we consume too much energy combined with too much sugar/fructose, or too much alcohol. So you are not entirely incorrect with what you are saying, because carbs in the form of soda and UPF do not just provide glucose and fructose, but also excess energy. Where I disagree with you is in the generalization to 'carbs'. The evidence is pretty clear that people who eat a high-carb diet rich in legumes, starchy veggies, fruit, berries, and whole grains do not usually overconsume calories, and in that context, they do not develop fatty liver, insulin resistance, or glucose intolerance. In fact, many studies show that body weight can be reduced by such a diet if if consists of whole plant foods, and that both insulin sensitivity and glucose tolerance improve. If you are open to considering the evidence, check out this video here on this topic, and click through to the blog post in which I link all references. The evidence in this area is of pretty high quality, and does not support the idea that - independent of weight change - carbs affect insulin sensitivity: kzbin.info/www/bejne/kJS5lqGLl9amj7ssi=lyFjMI8oPyv_jpEW

Congrats! That sounds like a major success! It's important to understand, however, that your story is not in contrast to what I presented in this video. There is little question that if people eat a lot of poor-quality carbs, such as added sugars and syrups, refined grains, or carbs in ultra-processed junk foods, they gain weight. And if they gain too much weight and the extra body fat can no longer be safely stored in the subcutaneous fat tissue, they become insulin resistant and potentially glucose intolerant. I explain this idea, called the Personal Fat Threshold, in the video linked below. kzbin.info/www/bejne/mYGYaKKDbdF1l7csi=M47CvkUFTx-Wg5NL And, of course if someone cut out these poor-quality carbs and they lose weight, the entire thing also works in reverse. However, it is important to understand that "carbs" per se never made you insulin resistant or glucose intolerant. If you had consumed the same amount of carbs in the form of lentils, beans, whole grains, starchy vegetables, berries, and fruit, you would not have gained weight, and in the absence of weight gain, the cumulative evidence as shared in this video shows that even very high-carb diets do not result in insulin resistance. This is important because it also means that we have other options to treat insulin resistance and glucose intolerance, such as very-low fat plant-based diets or high-protein high-satiety mixed macronutrient diets.

Lots of potential reasons. - Are you following a low-carb diet? - what’s the estimated HbA1c based on your CGM data? It is possible that your HbA1c could be false high, for example if your red blood cells have a longer life span than usual - could your glucose tolerance have improved since your last HbA1c measurement, ie, have you recently lost weight, changed your diet, or started to exercise?

Thanks for the reply! I have made some small changes like cutting out sweet tea and potato chips and other things like that. My CGM currently shows a GMI reading of 5.7. I'm looking forward to what my A1C looks like when I do my annual lab work.

That lean-mass hyperresponder phenotype applies only to people on a ketogenic diet, which doesn't sound like you are doing. On a vegan diet, having such high LDL-cholesterol would make me wonder whether that's mostly genetic. I certainly don't want to worry you, but if so, your cumulative lifetime exposure to apo B could be pretty high. I would certainly ask a cardiologist to also measure apo B and Lp(a), and discuss with me the overall risk considering my (likely) cumulative lifetime exposure to apo B/LDL-chol while also considering my other risk factors (which sound like these are pretty low risk for you). If the doctor brings up lipid-lowering therapy, that would likely be either a high-dose statin or a low-dose combination therapy of a statin and another lipid-lowering medication, such as ezetimibe. There is research to suggest that the combination of a low-dose statin plus a low-dose ezetimibe is more effective at lowering LDL-cholesterol while also triggering fewer side effects (insulin resistance, muscle pain). I would discuss these options with a (preventive) cardiologist. Cheers Mario

@@nourishedbyscience Thank you so much for that Mario. I will do as you say and set an appointment to visit a preventative cardiologist. There is no question Mario, you are one of THE BEST youtubers ever.

For people with manifest diabetes, going lower on carbs can be a good idea, because the body has a problem handling the carbs (mostly glucose). However, if you want to eat a bit of carbs, this sounds like a reasonable idea, ideally combined also with some protein in that same meal. That combination of fiber-rich veggies and protein slows down the absorption of the carbs, and the amino acids from the protein also triggers some insulin release from the pancreas. Cheers Mario

kzbin.info/www/bejne/eoexdWxmq7Zjrqs

Most grains have a fairly high glycemic index and particularly a high glycemic load. Whole grains may be a bit lower than refined grains, but I do think it's important to realize that all grains will have a fairly high glycemic load. So if someone is glucose intolerant (prediabetic or diabetic), it may be worthwhile to cut back a bit or a lot on grains, at least until glucose tolerance has improved.

It's normal to start rising within a few minutes, and most people reach a peak around 45-60 min. However, some people who have a diminished first-phase insulin response have a major spike in the first 15-30 min after starting to eat.