"Just eat whatever you want and cover it with insulin."
That was the advice Nayiri Mississian received as a type 1 diabetic. She learned that it didn't improve her blood sugars. No matter what she did, her blood sugars continue to rise. The one thing she didn't try was slashing the carbs from her diet.
A chance encounter with Jason Fung persuaded her to adapt low-carb diet and extended fasting in her lifestyle. Her blood sugar improved. She took her bio-hacking even further with extended fasting. The "experts" say diabetics shouldn't fast. Yet she found that extended fasts helped to reset her insulin sensitivity.
Her biohacking led to optimized health, stable blood sugars, and reduced insulin needs.
She shares scientific information about low carbs and fasting on her website and social media platforms.
Quick guide
03:27 Maintaining a healthy lifestyle for a type-1 diabetic
09:00 Being diagnosed 44 years ago
16:39 The life-changing insulin pump
22:18 What a higher A1c meant
23:49 No breakfast against doctor’s advice
25:43 Fluctuating blood sugars and its effects
27:10 Beginning a low carb diet
32:58 Eating meat and reducing blood sugar
39:53 Adjust the insulin dosage based on activity & food
43:50 The baseline of insulin needed to keep us functioning
51:21 Difference of type 1 & type 2 diabetes
58:59 Burning carb sugar or burning fat
Get to know our guest
Nayiri Mississian is a type 1 diabetic. She has over 30 years of expertise in the field of education and owns her own translation business, NTS Translation. She shares scientific information in her exclusive Facebook group and offers coaching services to help clients with their health.
"I don't know if that's important to mention here, but I don't I don't charge anything for that, and that can take quite a quite a big chunk in my day. I feel bad for having done or experienced something myself and not sharing it with someone who's reaching out to me. " - Nayiri Mississian
Connect with her:
Email: nayirimississian@gmail.com
Twitter: @NTSTranslation
Instagram: @lowcarbandfasting
Facebook: www.facebook.com/lowcarban
Chances are, you wouldn't be listening to this podcast if you didn't need to change your life and get healthier.
So take action right now. Book a call with Dr. Ovadia's team.
One small step in the right direction is all it takes to get started.
How to connect with Stay Off My Operating Table:
Twitter:
Learn more:
Theme Song : Rage Against
Written & Performed by Logan Gritton & Colin Gailey
(c) 2016 Mercury Retro Recordings
"Just eat whatever you want and cover it with insulin."
That was the advice Nayiri Mississian received as a type 1 diabetic. She learned that it didn't improve her blood sugars. No matter what she did, her blood sugars continue to rise. The one thing she didn't try was slashing the carbs from her diet.
A chance encounter with Jason Fung persuaded her to adapt low-carb diet and extended fasting in her lifestyle. Her blood sugar improved. She took her bio-hacking even further with extended fasting. The "experts" say diabetics shouldn't fast. Yet she found that extended fasts helped to reset her insulin sensitivity.
Her biohacking led to optimized health, stable blood sugars, and reduced insulin needs.
She shares scientific information about low carbs and fasting on her website and social media platforms.
Quick guide
03:27 Maintaining a healthy lifestyle for a type-1 diabetic
09:00 Being diagnosed 44 years ago
16:39 The life-changing insulin pump
22:18 What a higher A1c meant
23:49 No breakfast against doctor’s advice
25:43 Fluctuating blood sugars and its effects
27:10 Beginning a low carb diet
32:58 Eating meat and reducing blood sugar
39:53 Adjust the insulin dosage based on activity & food
43:50 The baseline of insulin needed to keep us functioning
51:21 Difference of type 1 & type 2 diabetes
58:59 Burning carb sugar or burning fat
Get to know our guest
Nayiri Mississian is a type 1 diabetic. She has over 30 years of expertise in the field of education and owns her own translation business, NTS Translation. She shares scientific information in her exclusive Facebook group and offers coaching services to help clients with their health.
"I don't know if that's important to mention here, but I don't I don't charge anything for that, and that can take quite a quite a big chunk in my day. I feel bad for having done or experienced something myself and not sharing it with someone who's reaching out to me. " - Nayiri Mississian
Connect with her:
Email: nayirimississian@gmail.com
Twitter: @NTSTranslation
Instagram: @lowcarbandfasting
Facebook: www.facebook.com/lowcarban
Chances are, you wouldn't be listening to this podcast if you didn't need to change your life and get healthier.
So take action right now. Book a call with Dr. Ovadia's team.
One small step in the right direction is all it takes to get started.
How to connect with Stay Off My Operating Table:
Twitter:
Learn more:
Theme Song : Rage Against
Written & Performed by Logan Gritton & Colin Gailey
(c) 2016 Mercury Retro Recordings
Nayiri Mississian - a Type 1 Diabetic Who Defied the Experts
SUMMARY KEYWORDS
insulin, diabetic, eating, blood sugar, fasting, cgm, diabetes, day, work, called, type, people, dangerous, remember, carbs, thought, glucose, keto, pump, sugar
SPEAKERS
Jack Heald, Nayiri Mississian, Dr. Philip Ovadia
Jack Heald 00:01
Welcome back to the Stay Off My Operating Table podcast. Dr. Philip Ovadia is your host, I'm Jack Heald, the talking hairdo. And we are joined today by Nayiri and I'm not even going to try to pronounce your last name. I think it's not... Go. Last name for me.
Nayiri Mississian 00:20
Mississian, kinda like Mississippi or Mississauga.
Jack Heald 00:24
All right, very good. Well, Phil, if you don't mind, tell us why this lovely lady is gracing our podcast.
Dr. Philip Ovadia 00:33
Yeah, just another person, wonderful person that I was fortunate to stumble across in the interwebs, as they say, and really excited to dig into Nayiri’s amazing story around her health. And I think a lot in our audience are going to benefit from hearing it and resonate with it. And just, I hope it really inspires people as to what's possible. So, with that, Nayiri, why don't you introduce yourself to our audience a little bit, and then we can get into your health journey.
Nayiri Mississian 01:16
Okay, so I'm Nayiri, Nayiri Mississian, host of the Low Carb and Fasting channel on YouTube. I've been a type 1 diabetic now for 44 years. So, I'd like to talk about type 1 diabetes today. Because that's something I know a little bit about having lived with it for 44 years. And my educational background is in linguistics. I'm a retired educator now and the director of a translation company, which I founded back in 2000, and nutritional researcher and a coach as well. That's it.
Jack Heald 01:58
The thing that... no not, there's not one thing. I read a couple of your blog posts. I like to get to know my guests before we start talking to them. One of the things that I was super excited about, hearing about was exactly the type the subject of your YouTube channel, low carb and fasting combined with being a type 1 diabetic. That's the bit that's the twist that we have I haven't run into. I think what I'd like you to talk about is how is this low carb and intermittent fasting approach to health and eating different for a type 1 diabetic.
Nayiri Mississian 02:53
Well, the bottom line is, it doesn't have to be different. I mean, for a type 1 diabetic, healthy lifestyle doesn't have to be different. There are precautions to be taken. As you know, type 1 diabetics are insulin dependent. And so constantly, they have to adjust their insulin needs based on their activity levels. And also based on how much food or what food they're eating. So, insulin levels need to be adjusted. So, that's something that needs to be taken into account when a type 1 diabetic is doing intermittent fasting or extended fasting for that matter, as I do on my blogs are on extended fasting. So, insulin needs to be adjusted. During physical activity, for example, you might have either a drop or rise depending on the type of exercise. And also, depending on, I mean, there's so many nuances there, but they’re also depending on how much insulin you already have on board, because insulin injection, that inject remains in your system for good 3 to 4 hours. So that insulin will also be working while you're doing aerobic exercise, for example, going swimming or walking. So, the likelihood is that while you're going swimming, or walking, and you have insulin on board already, you're going to have a sharp drop. You will have a drop in your blood glucose so you have to avoid that. So, there are so many complexities with management of type 1 diabetes, but if you have the confidence and the right knowledge, and the right tools, you can do it. You can experiment and see what works for you. You must do it safely. And if you don't have the confidence, please do it with the help or advice of a physician. But the right tools for me, if I can mention those, I'm not affiliated with any of those companies, but the one of the tools that I use, of course, is my CGM. This is the FreeStyle Libre continuous blood glucose monitor. So that tells me continuously what my blood glucose is. So, all I need to do is use my phone and I just put it, hold it against the sensor, that's called a sensor, I can scan it, and it shows my blood glucose, I don't have to do any finger prick testing like I used to, before the CGM came about. Another important tool is my insulin pump. I currently use a tubeless pump. So instead of taking injections, with those disposable syringes, gosh, I don't miss those anymore. I've used them for years and years. I have a pump. So basically, a monitor, this is the Omnipod pump. As I said, I'm not affiliated with them. It's not the brand-new version, but it does its job really well. So, all I need to do is input how much food or what food I've eaten, mainly carbs. And then it calculates based on the data that I've put into it, how much insulin I will need for it. And that insulin comes through a little patch that I have stuck. Currently, it's on my back, otherwise, I would show it to you, so that you stick somewhere on your body. And it has a tiny little reservoir in it. And it contains about three days' worth of insulin. And so, this is the control device, I just do all the sort of give it the input it needs. And it calculates how much that little device stuck on my body, how much insulin it should deliver into my body. So, these are the tools that I use. And that also gave me the confidence to tweak my insulin needs based on whether I'm fasting or not. Or whether I'm eating carbs or not, which I don't. I mostly don't eat any carbs. And based on my activity levels.
Jack Heald 07:23
I was fascinated by the fact that you are your what we call a bio hacker, you hack your own biology. I was really impressed as somebody with what, as a non-medical professional, I've always considered type 1 diabetes to be... That's one of those really serious things you just don't screw around with and I was just impressed that you engage in that kind of biohacking. Phil, I know you had a comment...
Dr. Philip Ovadia 07:59
No. Actually following up on that Nayiri. Tell us a little bit about your early experiences around type one diabetes, some of the advice that you've got, early in your life about what to eat and how to kind of manage your life with type one diabetes, and then maybe that will lead into how you got to where you are today.
Nayiri Mississian 08:26
Okay, so I was diagnosed 44 years ago, I was born and raised in the Middle East. So, I was diagnosed all those years ago. I don't remember much of life before I was diagnosed. But I do remember the day I was diagnosed and I remember being at the hospital, and not understanding anything. I think I spent the night there. And I remember my tantrums when it came to the daily injections, which grandma, mom would literally force onto me, they would physically restrain me so I would take my daily injection because I would die without it. They didn't know any other way. It wasn't that they were being cruel. They just didn't know how to handle it. I remember crying kicking my legs. I remember all the tantrums. I was very young. I remember grandma telling me, “Shhh, you're waking up all the neighbors.” I didn't care. I think I've rebelled and resisted for as long as I could until I couldn't do it anymore. It was tiring. I had to accept being diabetic and having to inject myself every single day. Now, I don't remember sort of restriction because I don't remember what I used to eat before. I don't remember the daily portions of cake and then suddenly I was told you couldn't eat cakes. I just don't remember that transition. But it's interesting, I need to mention this, in those days and we're talking the 70s and maybe even early... No, but all of pretty much all of the 80s. The dietary advice, at least in the Middle East, but I also found out recently that it was the same in Australia and probably the US as well, the advice for diabetics was to limit carbohydrates. Not necessarily not to eat, but just not to eat sugar and limit carbohydrates and focus more on complex carbs. So, I remember the meals mom would make for me, for example, and she would put only 1 tablespoon of rice, and a lot more lentils, for example, if that was what we were eating. So, she'd give me more chickpeas and less of the cracked weeds or bread. I remember that. And that's how I was grown up basically eating clean food, homemade foods. There wasn't processed foods back then were certainly not when I was growing up, and it wasn't something we ate at home. So, it was mainly lower carbohydrate sort-of diet home cooked clean, as clean as it could be. Until I came to the UK as a young adult to study. So, I came to the UK and one of the first things I did as a responsible type 1 diabetic was, of course, I had to register, well, at the local diabetes clinic, which was based at the Hospital in Cambridge at the time. And that's when during my first visit, I actually found out that there is such a thing as... There is such a thing as diabetics don't need to worry about eating differently. We have insulin, we have good insulin and that's what insulin is, therefore, just eat whatever you want. And match it with insulin, cover it with insulin. That was totally new to me. And of course, I fully welcomed it. I remember calling my mom and saying, “the doctors in the Middle East, they knew nothing. They know nothing." Don't ever tell me not to have a Coke because if I wanted to Coke, not that I ever liked Coke that much, but I just I literally told my mom all those years you kind of not giving me enough bread, now I'm gonna make up for it because I know what can cover it all with insulin. That's what they're telling me at the center. So, I thought that I was raised in somehow in the wrong way, that I was deprived somehow that but that only came to me when I moved to the UK. And that's how I lived for over 20 years in the UK, eat what you want, in fact that it was good and important to eat carbohydrates and that all I had to do was cover it with insulin. But of course, we know, Dr. Ovadia, you'll know it's impossible, it's virtually impossible to manually take the right dose of insulin to match and regulate your blood sugar rise and drop. You just cannot replicate a working pancreas. You know the way they think we can? It's just impossible. It's virtually impossible. So, we're unhealthier and unhealthier, of course, over 20-25 years, until I found low carbohydrate diet.
Dr. Philip Ovadia 13:33
Yeah, and before we get to that, I'll just kind of verify because my brother, my older brother is a type 1 diabetic. And the advice I saw him acting upon, really his whole life while we were growing up in the 1980s here in the United States was exactly that, that you just had to match your insulin to your carbohydrates and I remember him, always sort of doing the calculations and figuring out how much insulin to give him. This was of course pre insulin pumps and all of the great technologies that have come along, but the direction from doctors then and unfortunately, this largely continues today in mainstream medicine and in the diabetic community, diabetic nutrition community is exactly that, that you don't need to restrict anything. You just need to match your insulin to the carbohydrates that you're eating.
Nayiri Mississian 14:38
I mean, the funny thing is which diabetic wouldn't welcome such a message? It's what you want. You don't have to watch your diet. I mean, for goodness' sake, I don't have a working pancreas. How do I... How can I not watch my diet? But they told us, you don't have to watch your diet. Live like everyone else and just take your insulin And, of course, I tried that, and my HbA1c, which would average a bout, I would say 7.8, which is 662 millimoles back in the Middle East. So now in my 20s, perhaps exacerbated by the fact that I was, stress student, or that workload and everything made it worse. But primarily, it was the diet. I know, it was the diet, I was eating carbs, I suddenly started eating tons and tons of rice and bread and pasta. Thinking it was okay. And I could just control my blood sugars with insulin. And of course, my HP and once I remember the highest being, it's probably been higher than that. But I, the one I remember was 12.8%, which is 116 millimoles. Now that is a dangerously high, A1c level. That's when at the hospital they told me, “Nayiri, we're going to give you an insulin pump. And that's going to be life changing for you, it's going to improve your control. It's going to bring that HbA1c the or the A1c equal down to normal levels.” I welcomed that, of course. I loved my very first pump, it was a Medtronic pump, we’re going back 16, 17, maybe even 18 years, I don't recall. One of the very first Medtronic pumps, it was a tubed one. I remember hiding the tube, it just didn't look good at hiding the tube under my clothing, but the device itself was tiny enough. And I would mainly put it in my pocket and go to work or go to the university. And they were right. It was life changing for me not having to take multiple injections every single day. So, in that respect, it was life changing. It gave me freedom. But my HbA1c did not come down. So, the pump was just another method by which I was receiving my insulin. So instead of these disposable syringes, now I had a pump, and eventually I dreaded going to my annual checkups. Because my A1c wasn't coming down. They wanted to see me every 6 months, because I was kind of a special case. And I was talking about conceiving at the time. So, they thought we have to monitor her, we have to bring her A1c down. Nothing they did, nothing that I did would bring my A1c down. I remember them, this was pre-CGM, so I would have to do finger prick, blood test about 8 to 10 times every single day until my fingertips are so sore that I just dreaded doing it. But they forced me to do it. They said, once we give you the Okay, then you can go and conceive or try to conceive. They just and I mean, quite rightly so, they did the right thing. They wanted to help me bring my A1c down. So, they would call me 3 or 4 times every single day from the hospital or from the diabetes clinic, checking on how I'm doing. But of course, there was no mention of hey, lower your carbs. There was absolutely no mention of what I was eating. They were just monitoring me. I became accountable. And maybe that helped slightly because my A1c came down slightly from 116 or 12.8. I can't remember what it came down to. And then I was pregnant, of course, but how did I discover low carb? I was playing on YouTube; I can't remember what I was searching on YouTube. And I came across one of Jason Fung’s videos then I watched another and then another and then another. And it all made sense to me. It all made sense that I thought I'm going to try this because you said by that point, this was in 2015 when I first started very slowly transitioning into low carb but by that point, I was already trying to make changes to have better A1c levels and of course I went to the extreme of okay growing organic food at home and I thought okay, how can I get healthier? Stop buying supermarket produce? So, you have to grow every day and I’m in the UK. UK, of all places, where you fairly ever see the sun. Jack, you'll remember from your UK days. I managed to keep an organic garden that which gave us enough produce through the summer months. I would wake up before going to work, wake up very early every morning and make a loaf of bread, fresh bread for that day because I ordered in fact, the best quality whole wheat flour because I assumed it was healthier and I would make bread at home. So, we wouldn’t have to buy the shop-made ones. We'd even make pastries and even pasta machine. My husband would manually just operate that pasta machine one of those old-fashioned wants to make us pasta at home. We did everything to the extreme to be healthier, but it just wasn't possible because we were still eating carbs.
Jack Heald 20:57
Okay, real quick.
Nayiri Mississian 20:58
It doesn’t matter if the pasta was shop bought or homemade. It was still pasta. It was still made of flour. It had the same impact on my blood sugars.
Jack Heald 21:07
That's what I wanted. I want to hear because I'm not familiar with what it is, what life is like to be a diabetic, let alone type 1. What was your health situation at this time when you stumbled on Jason Fung’s Videos? What kind of symptoms were you dealing with on a regular basis? What was your life like prior to finding this?
Nayiri Mississian 21:35
Well, my A1c was always higher than...
Jack Heald 21:40
What was the effect of that? Did you feel anything?
Nayiri Mississian 21:43
Yeah, that's the average blood sugar. But that also meant that my daily blood sugar figures were also all over the place. Would go right up. Right up and down. I would go right up after pizza or pasta which no one ever told me, “Don't eat.” I would have been able; I wasn't addicted to food. I have never had this, I mean as far as I know, I've never had food addictions. I would have happily given up the pasta and pizza but no one ever told me or the French fries. I had no idea. So, I would feel permanently fatigued, just constantly fatigued. I remember feeling nausea as well. Feeling like, because my blood sugars were constantly high, so I felt sick. In fact, I've used to feel like that in the mornings waking up. I'm probably now with hindsight. It was because I was waking up with high blood sugars. And I wasn't checking my blood sugars regularly so with hindsight, I know that it was probably because I was waking up with high blood sugars. And the last thing I'd want to do when you're just woken up with high blood sugars is eat and so I remember without my doctor's or in fact against my doctor's advice, that was one of the first things I did back in the year 2000s, we’re going back, I stopped eating breakfast and I stopped taking my morning injection.
Jack Heald 23:29
I remember you read us writing about that.
Nayiri Mississian 23:32
I stopped eating. Well, I thought I won't take insulin and I will skip breakfast until I just have my lunch at work. I remember my doctor just telling me, “Oh no you can't do that. You can't skip breakfast. At least have a protein bar, have something.” And of course, protein bars are just we know are full of unhealthy ingredients. But they're also carb bars. Basically, they're anything but carbs. So, I didn't take any of that advice. I just couldn't stomach anything with high blood sugars early in the morning. So, I just decided not to eat. In fact, I joke to my friends saying the last time I had a morning meal or something to eat, the last time I had breakfast was the year 1999 and it's true. It is actually true. I haven't had breakfast, or a morning meal since then. So that was one of the first things I did back then. Against my doctor's advice. But yes, it's not a good feeling. You feel constantly tired, you can't focus. Of course, I couldn't focus at work. I was just so tired by 2pm. All I wanted to do was just get back home and have a nap or have a sleep because my blood sugars were constantly high or if they weren't high, they were fluctuating all day long. Up and down and up and down.
Jack Heald 24:57
What is the effect? What is the experience that you feel when your blood sugars are fluctuating up and down like that?
Nayiri Mississian 25:08
Okay, when they're rising and rising real high, I would feel physically sick, like almost like vomiting. I would have blurred vision. I would have a loss of mental sharpness or not being able to focus. Maybe feeling of thirst, although I don't remember much of that generally drink a lot of water. But I also I mean, one of the worst things from my past or karbi days was the constant yeast infections, and I would be told at the clinic this is pretty common with diabetics. And all they will do is just prescribe Canesten cream and that's it, they'll take care of it. I remember it was constant, I just recovered from one and a month later yet another one, yet another one. And of course, that was a direct result of high blood sugars. But I wasn't told that. Oh, take your Canesten and just that was sorted out, of course, just treating the symptoms rather than what's causing it. Okay, I don't want to go back to those days at all.
Jack Heald 26:29
So, you stumbled onto Jason Fung. And then?
Nayiri Mississian 26:36
I thought I'd try. I thought I'd try it. I think one of the first things I cut out was flour. I did it really slowly, because I didn't have the support. And going back into 2015, the community low carb, though, there wasn't from what I remember, there wasn't a low carb community online either for support. I couldn't talk to my diabetes clinic about what I was doing because the one time that I mentioned it, I was dismissed, and I was told, oh no, it's dangerous thing I'm doing and that I needed to eat carbs, especially if I wanted to have another baby. In fact, I was told specifically there, I know that to be total nonsense. It's just not true. But so, I did it alone. So that's why I did it very, very slowly. So, one of the first things I cut out was, of course, the white sugar and flour. So, they went out. And then gradually I started cutting out other carbohydrates like beans and legumes, I think you call them right up lentils and chickpeas and other stuff like that. So, I cut them out as well. And I noticed over time that the more I was restricting my carbohydrate intake, the better my blood sugars were getting, the better the daily variability was getting. And the less hungry I was feeling. So basically, avoiding the carbohydrates was having a good impact on me. I wasn't feeling hungry anymore. I wasn't snacking constantly. I wasn't having ups and downs all day long. And I was more energetic. And of course, the yeast infections completely disappeared. This appeared and have never come back in seven years. So, it was in 2018. It was in 2018. I was new to this, still had been a couple of years or 3 years. I woke up one day with frozen shoulders. Doc Ovadia, you probably know diabetic, frozen shoulders, I mean, are incredibly painful. It started off with my one of my shoulders. And then a few days later was the other shoulder and they were locked. I mean, I couldn't move my shoulders. And they were so painful. I couldn't even put my clothing on without help. I couldn't sit at a table and eat because I couldn't move my arms at all. And cry in pain. I went to see my doctor and they told me we'll have to give you injections. I think it was cortisone, cortisone injections, and that will help with the inflammation. But of course, at no point did anyone address the root cause. Why did you have frozen shoulders? How can we avoid or prevent another one or your other joints from getting inflamed and getting blocked and bent? In fact, they didn't tell me anything. I refused the injections. And they specifically told me, “Don't exercise,” and I told them what I don't anyway, because I've never stepped in a gym until 2018. But that day, I came back home and I told my husband, I'm coming to the gym with you. My husband is a former athlete, and I can't continue how delighted he was to hear that I wanted to join him in the gym. And from that day with frozen shoulders, I hit the gym, and no I’m able to lift weights close to twice my weight. So, which is quite an achievement. I'm very proud of it actually. I'm close to 50. So, having never stepped in the gym before because I didn't like the look of muscles, especially on females. I didn't know that about the importance of having the strength. I just had no idea. I thought it was just muscles were for looks. And so, no, they're not for me. But now since 2018, I do serious training resistance training about 4 to 5 times a day.
Jack Heald 31:09
I can't let this frozen shoulder thing go unexplored. You talked about the root cause. But you didn't say what the root cause was. And you didn't tell us how you got through it. What happened? You got frozen shoulders and then?
Nayiri Mississian 31:27
And then it wasn't long after actually, I had the carpal tunnel syndrome, which is when... Yeah, so my fingers started, the joints in my fingers started bending. In fact, I can show you now they're all fine apart from just this finger is slightly bent still. So gradually, I have to say that I think gradually, I found out about the link between inflammation and vegetable oils or seed oil. So, yeah, there's a big link. So, I started eating only coconut oil and olive oil. So that was one of the other things I did apart from obviously lowering my carbs even more. And I realized I had to introduce meat because I was vegetarian. I've been a vegetarian for 30 years. So, in 2021 I believe I yeah, last year. Last year, I introduced meat into my diet for the first time in 30 years. On my birthday. I did it on my birthday, I thought that would be a good day to remember in the future as the day I started eating meat. I think that's helped with my strength levels. It's helped with my blood sugar levels, because they're more stable. I put out a tweet today showing some examples of what kind of blood sugars I'm having in a day, and they're normal, they would be emitted from nowhere. If someone didn't know I had type 1 diabetes, they would take those blood sugars, as of someone who doesn't have diabetes, so I'm very proud. I mean, it doesn't mean I have perfect blood sugar control. I'm constantly learning and experimenting and each day is a new day. And what works one day doesn't necessarily mean the next day because there are so many variables from stress levels, sleep, activity levels, even how hot the weather gets and how much I'm sweating sitting at home. For example, if I don't have the AC on, and I'm sweating, my blood sugar's gonna drop. There's so many variables but all I do is I monitor my blood sugar's constantly; I make a point of keeping my blood sugars in range. And the range that I've set for me, which is my target goal where I want to be is a lot lower than what Diabetes UK in the UK and I'm probably the same for ADA recommend. And I put out a tweet today because I'm just so frustrated. Another type 1 because I'm constantly helping type ones other Facebook group, we share ideas and experiments and we try and support each other because we don't have that level of support that we need from our physicians so we try and support each other. So, bless her. She said, “But they told me at the hospital to set my target goal up to 10 millimoles. I mean that is 10 millimoles is high in my books. It is 180, 180 milligrams of a deciliter. So that's high. So if you're telling diabetics that no, as long as you're staying within the normal range up to 180, then you'll be fine. Well, no, I'm sorry. But that is not the scientific truth. You can expect better, you can do better. In fact, you are type 1 listening to this. I know it's overwhelming, but raise the bar for yourself, raise your expectations, because you can. Trust me if I was able to do it and it was so close to giving up because I thought I was a failure. Anyone can do it with the right tools and with the right support, so never give up. No, it's not normal to have blood sugar's hovering at 180 all day long, or going up and down. That is not normal.
Dr. Philip Ovadia 35:58
So, when you see your doctors now, and you, oh, they see your blood work, they see how much better your
Jack Heald 36:08
Phil, your signal flipped out there just for a minute, I just want to make sure that we get it. So, if you don't mind, please repeat your question.
Dr. Philip Ovadia 36:18
So, when you see your doctor's now and they see your blood work, and they look at your A1c and they look at your logs from your continuous glucose monitor, and I'm sure they're thrilled about what they see, because it's better than probably 99% of their type 1 diabetic patients, what do they say when you tell them how you've achieved this?
Nayiri Mississian 36:43
Well, times have changed and my diabetes doctor himself has changed. So, over the last 7-8 years, and there's more acceptance now, I think we're certainly where I'm treated. So, my diet diabetes consultant, or endocrinologist, as you call them, is supportive. But he does tell me, “Look, do what you're doing because I really don't know how to support you, I really don't understand the low carbohydrate zero way of living as much as you seem to be. So just continue to do what you're doing.” The only thing he was concerned about though was that with strict keto or k33eto 4, which is mainly animals are the base products, this is what I eat mainly with some small amount of veggies or berries every now and again, what happened was my LDL went up only slightly, not much, only slightly. And he was concerned about that now, so is it. I recommend you take statins, I said, no doctor, politely I will refuse. And I contacted Dave Feldman to see if I could sign up in his study, because he was asking for volunteers who are lean mass hyper responders or lean people like me, generally fit, who are on keto, and whose LDL have gone up. And he said, but your LDL isn't even high, you don't know... We’re looking at much more 10 times higher than that. So, then I just sat back and I thought, Okay, well, then. So, but adapting meat back into my diet wasn't such a such a bad thing. Maybe that's why LDL went up? I don't know. But I don't much care about it. So, I'm doing really well. They used to tell me you have to... The ideal for you is 5.8%. So that's where your a A1c needs to be. So that's 40 millimoles, 5.8%, which is normal. So do A1c. And that number had evaded me for decades and decades, and I caught myself as a failure because I never get anywhere close to that. And now of course, my recently, A1c was 5.5177%.
Dr. Philip Ovadia 39:08
Yeah, amazing work. And just what would you say your average daily dose of insulin is these days?
Nayiri Mississian 39:19
So, as I said, having the pump and adjusting my insulin dosage on a daily basis based on activity and food and whether I'm having 1 meal because some days I only have 1 meal, and I'd be fasting for about 20 to 23 hours, and some days I'll be having 2 meals in a window of 4 to 6 hours. So, depending on what I'm doing, it could be anywhere between 16 units per day to 28 units per day and 28 would be on the 2 days when women ovulate. So, it would be it would be a lot more insulin on those 2 days. But other than that, it's general average of I would say 20 units per day.
Dr. Philip Ovadia 40:11
And back when your hemoglobin A1c was 10, 12, back in those days, you remember about how much insulin you would go through in a day?
Nayiri Mississian 40:22
40. I remember the 40. But I don't remember. I don't remember the details. So.
Dr. Philip Ovadia 40:28
So again, a lot more insulin, and a lot worse blood sugar control. And yet, this is still not considered an acceptable way to manage, diabetic type 1 diabetics, for the large part, which is just simply amazing. One of the, as you know here in United States, the cost of insulin has become a political issue. It's, it is out of control. And there are many diabetics who can't afford their insulin or have to choose between, putting gas in their car and buying insulin, which is horrible, and yet no one in that discussion on a political level says, if we helped diabetics to better manage their sugars, they would need less insulin like yourself, and many others have demonstrated, while you're while your story is amazing, it's also not unique. We're seeing more and more type 1 diabetics, certainly the type 2 diabetics that are able to achieve, similar results with these changes in their diet.
Nayiri Mississian 41:42
Yes, I'm certainly not the only one. I have a Facebook group for people who also are doing keto, but also extended fast. I mean, there are type 1 diabetics in my group who are safely fasting for 5 days. And why not? You're able to do it safely and manage your blood sugars, why can't a type 1 diabetic do it? I just don't understand why you would be different for a type 1 diabetic, as long as it's within sort of within safe limits.
Jack Heald 42:17
I want you to talk about fasting now because that's probably, to this layman's mind, the most surprising thing about your story. I've been with Phil now for a year hearing these stories over and over again, and all the extraordinary health benefits of a low carb high fat diet for all kinds of medical conditions. But one of the things I've just always assumed, because I'm an idiot I guess, is that if you're a diabetic, fasting is really dangerous. Clearly, that was misinformation. Talk more about that. I want to hear about your journey. This epic journey that you have with fasting, extended fasting.
Nayiri Mississian 43:16
I think I'd like to start with going back to when I was first diagnosed, so we're looking at the 1970s. For example, back then, I would take a set amount of insulin in the morning to cover me for all the meals I was eating throughout the day, that was a completely different kind of insulin. So, I would take that insulin first thing in the morning. And then of course, you would have to wait because otherwise your blood sugars would drop dangerously low. I remember being in first grade, for example, and my teacher would bring me food to eat at a certain time in class, and I'd be so embarrassed as a five, six-year-old but I remember that vividly because mom would bring my lunchbox to school. And I had to have my meals at set times because I've already taken insulin for it first thing in the morning. And then life became a little bit sort-of easier when we were told, take your insulin just before you eat about 20 minutes before you eat, or even during the time that you're eating, just take your insulin to cover the meal that you're eating. So, I did that too. So, if you're not eating, I mean, okay, I have to mention the 2 types of insulin first for type 1 diabetics. We all need a basal level of insulin. It's our sort of baseline insulin levels to keep us functioning and a lot. Because insulin is not just the bad guy. Insulin is very important hormone without which, as type 1 would know, we wouldn't be here, we wouldn't survive. So, we need insulin. We need a baseline of insulin to keep us alive. Once you figure out how much you need for your baseline level to keep your blood sugar steady throughout the day, then you can get away with just not eating. Skip your meals, don't eat, and nothing will happen. You're not taking any carbs; you're not taking any further insulin to cover the carbs. So, you're not having risers, you're not having glows, all you're doing throughout the day is not eat, enjoy your day, and just take your baseline level of insulin that is the level that we all need. Now, this is what happens when I'm fasting. So, when I'm fasting, I'm basically not eating and because of my eating, and I'm not taking any carbohydrates, or in fact, any calories, any food, then, then I don't need to take any further insulin, which is called bolus insulin. So, I'm not taking any sort of bolus insulin to cover the food that I'm eating. So, if I'm not eating, all I need to worry about is the baseline insulin level. But to get that right can be a bit of a challenge. You need to experiment, you need to try it out, you need to try it for several days to see what works for you. And, I would say if you find yourself dropping too low, take a glucose tablet. Take a glucose tablet, bring your blood sugar back up again, and make a record of it, write it down in your notebook. So, the next time you're going the whole day without food, you know to reduce to your baseline insulin because the last time you read it, you dropped obviously, that was a bit too much insulin for your body's basic needs. So, if you find yourself dropping, take glucose tablets, you have to treat your low is dangerous. Take your glucose tablets. And don't worry about it. It's not the end of the world. Try it again another day, but with much less insulin. And if you reduce your insulin, say from 10 units per day as your baseline level, you reduce it to eight units. And now you find that you're having too many rises throughout the day. Well, it just basically means that 8 units was not enough for you. So go for 9 next. Nine will be the only one in the middle. That's just an example. So, when I'm fasting, not eating throughout the day, I could probably take only about 6 to 8 units, sometimes even 5 units of insulin per day. That's all I need to stay to stay alive.
Nayiri Mississian 48:16
Now it's more challenging when your first is longer, of course, because on the second day, you're becoming more insulin sensitive. So, the 8 units of insulin for your first day may have worked. But on the second day, you'll find that you've got no more glycogen stores. That's probably what's happening Doctor Ovadia, you might be able to contribute here. So, you've completely emptied your glycogen or sugar stores in your liver. So, you have no sugar, nope, no sugar on board. And so, the 8 units, which works for your first 24 hours, but might be a bit too much for your second 24 hours. So be prepared to reduce the eight units to say six units for your second day. So, it just involves a lot of tweaking and adjusting, but you have to take it seriously. It's not a game. It's your life. I mean, we don't want you to drop too low. And we also don't want you to have dangerous highs. If you don't have sufficient insulin on board, you might develop a condition and your blood sugars are rising too high, you might develop a condition called ketoacidosis which is DKA sort-of fatal condition so we don't want you to be irresponsible. It's not a game. Do it safely and always ask for support and where possible, use the tools available for you like CGMs or a pump, although pump isn't essential for extended fast. You can still adjust your insulin dosage, whichever way you're taking your insulin. But a CGM is really important because it would record dangerous lows or dangerous highs when you're sleeping through the night and the alarm would go off to wake you up, so you can address it. So, it would basically keep you awake. So, I don't think I would have the confidence. I'm not saying I wouldn't do an extended fast without my CGM. But I certainly wouldn't be as confident to the weight without. And I know that every type 1 in my Facebook group who does extended fasts, or even intermittent fasting, every single one of them has a CGM.
Jack Heald 50:43
If you're a type 2, rather than a type 1, are the rules all basically the same?
Dr. Philip Ovadia 50:47
No, it's very different, we have to realize that type 1 and type 2 diabetes only share a name, they're really completely different diseases. And it's kind of crazy that we think of them as the same, type 1 is when you can't make any insulin. And type 2 basically comes from having too much insulin in your body over an extended period of time. And the only thing they really share is that you end up having high blood sugar, but they're completely different diseases and, things like fasting and low carbohydrate diets. I mean, certainly they benefit, both benefit from low carbohydrate diets and fasting, but I agree with nearly that, fasting for type 1 diabetic is not something to be taken lightly. But it is possible with the right guidance and with the right education, and I think it can be a great tool for them to use, I do want to touch on something, low blood sugar hypo, as they're called, getting hypoglycemic is a major issue for most type 2 diabetics and talk about and it's life threatening. You can die from having low blood sugar as a type 1 diabetic. And it also is one of those things that can be pretty miserable in terms of symptoms and quality of life. So, talk about the difference now, versus, in the past, as to how often you would get hypoglycemic. Most people would assume, oh, you're not eating carbs, you're fasting, you must get hypoglycemic all the time. And I suspect that that's not the case.
Nayiri Mississian 52:44
As I said, no, that's not the case, if you're not taking insulin, or too much of it at the same time. So, if you're not eating and taking too much insulin, yes, you are going to have a severe hypo, which is dangerous, and you may even need assistance, someone's assistance to recover from your hypo. So, it's a dangerous condition. But low blood...
Jack Heald 53:12
Oh please. Yeah. Because Phil is a surgeon, sometimes he gets calls and so continue. Please continue.
Nayiri Mississian 53:25
Yeah, so as I said, so low blood sugars are not fun. You want to avoid them at all costs. It doesn't mean that if you are eating a low carbohydrate diet, you will never ever experience a low blood sugar. You may, but those instances will be a lot lower, and those lows will be less severe, and will have less of an impact on your health and on your social life. For example, before when my diet was high in carbs, I would rise literally within 30 minutes of eating a whole bowl of 80 grams of pasta. I remember the 80 grams because I would do carb counting in order to match my insulin to the cards. I even attended courses on carb counting. And I thought now I have all the skills I need to manage my diabetes. But of course, it didn't help but I was able to count carbs. So, I would count my carbs. Take the right dose of insulin, or the recommended dose of insulin to cover those carbs, but I will still rise. After a bowl of pasta or bread, I would rise a sharp rise and would then I would say in an hour or two, I would have a sharp drop. So, a sharp rise would lead to a sharp drop and now as I will be dropping down from a peak, from this Himalayan peak, as I would be dropping down, even before I get to low figures, or what's considered hypoglycemia, even before I would take those levels, I'd start experiencing hunger and shakiness and blurred vision. So, I would actually experience the same hypoglycemic symptoms when I wasn't even hyperglycemic, technically. I would just be dropping down. And as you're dropping down, blood sugar’s dropping down, what happens is your ghrelin is the hunger hormone would go up. So as ghrelin is going up, you're craving food again. And this is what happens to non-diabetics as well. That's why they're craving carbs. After a bar of chocolate, they're craving another one or another snack every hour, because blood sugar is dropping This blood sugar is dropping sharply, you're craving more food, because ghrelin hunger hormone is going up. So now because I don't have the sharp rises, I don't eat carbs, and if I do, they're under 5 grams a day, if I do so. I mainly eat protein. So, I take insulin to cover my protein because a portion of the protein would still convert to glucose. So now my risers aren't sharp, so I don't have the sharp rises. Because I don't have the sharp rises, I don't have the sharp drops either. So, I don't have those constant cravings and constant feelings of hunger. And then I have to eat again and again, I virtually feel no hunger. I could go on for 24 hours and longer without food simply by burning my own stored fat. If I may, I'd like to mention an experiment they did in 2020 in the UK, and it was called a project. It was called the Zero Five 100 project masterminded by Dr. Ian Lake, who is a GP, general practitioner, primary care doctor in the UK, who's also type 1 diabetic. And so, the participants ran 500 kilometers, I think, or maybe it was miles, 500 miles over 5 days on 0 calories. They totally fasted. And some of the participants were type 1 diabetics. So, 5 days of no food for 5 days, so the whole run would last 5 days. And they compared the blood sugar because they were wearing CGM, the blood sugars of diabetics to non-diabetics. And they found out there that when people were obviously burning fat, stored fat in those 5 days, they weren't eating anything.
Nayiri Mississian 58:15
So, blood sugars of some of the non-diabetics would go, what your ADA would now consider, oh, no, that's dangerous, that's a low. There would be like what you would consider technical with the Diabetes Association think of as low but they would run low. As well as the type 1 diabetics, they would run low for days. And they'd be in perfect physical health, mental health, because their body was not relying on sugar. So, when their blood sugar was a little bit low, the brain and that is the explanation of being able to understand from it, the brain was not panicking, the brain was actually switching to fat burning, so the brain itself, it's another misconception because we think, okay, your brain needs glucose. But in those instances when these people were having lower blood sugar, so there wasn't enough blood sugar to fuel the brain, then the brain was actually burning fat instead. So that's another definition of... I think we have to define what a low is differently for someone who's eating a high carbohydrate diet, or for someone who is not eating, was a fat-adapted person who's burning fat for fuel. Because if you're burning fat for fuel, you're not panicking. Your body is not in panic mode. You're in full functioning mode when you are at a figure of 65 milligrams in your measurements. And that's blood sugar measurement. 3.6 That's the case with me as well, and I know a lot of other type ones who are on keto. 3.6 is normal blood sugar for me, I could stay 3.6 all day long, not go up, not go down, that’s 65. Whereas in my carb eating days, at 65, a level of 65 would be quite dangerous for me, I wouldn't be able to function, I would have to find my husband say, come help me, I'm dying. So that is the difference. The difference is whether you're a carb-sugar burner or a fat burner. But for those of us who are fat-adapted, I think our metabolism needs to be taken into consideration. That's one thing I don't like about my current CGM, because when it gives me graphic representation of my daily sort-of graph, anything lower than 70, it turns the line into a red line. It just wanted to appear as red. That’s really dangerous, but that is not... For me, that is not that. I've tried to change the color. It just comes. It's a default system. I cannot change that red. I hate saying it because it just leaves the impression Hey, but there's something dangerous, in those two hours were dangerous for you. And yet they weren't dangerous for me. I think that's something that CGM companies need to take into account and trust people. I know they have safety; they have safety to think about, but they also have to give diabetics the trust that we need. So, we can use their device to manage our diabetes as best we can. I've tried contacting Abbott, asking them questions about why they insist on doing this and haven't been able to work to reach them. So.
Jack Heald 1:02:04
So, tell us a little bit... I have to tell you, I have learned things, I've had misconceptions corrected during this conversation, for which I'm grateful. One of the things that I am surprised to have learned is how the type 1 and type 2 are really two different diseases and therefore have to be managed in entirely different ways. And I'm also getting that those of you who have type 1 diabetes, in particular really need one another's support and the shared experience things we've learned that work. And I guess that's at least a big part of what you do these days. Tell me more about that. You're coaching your Yeah, give us the give us the 411 on that, by the way, in America, the 411 is colloquialism for, give us all the information. I apologize there for our international listeners.
Nayiri Mississian 1:03:21
I’ll do my best to give you my 411, my five cents or two cents, or whatever it's called. Okay, well, thank you for bringing that up. Yes, I think all diabetics or anyone with any health condition, you will need the support of one another, we all benefit from meeting other people with the same condition and sharing experiences. I mean, that's for whatever condition you have. And for type ones, who are doing keto, we're a much smaller group. And for type ones who are doing keto and fasting, whether it's intermittent fasting or extended fasting now that even narrows the group down more, so you're not going to go down the road and meet or meet your next-door neighbor in the same boat. So, you do need to use social media to find other people who share the same experiences. But even then, you're likely to find that people are doing pretty much the same thing in different ways or you will find that what works for you may not necessarily work for someone else. So, because there are so many variables and nuances. I'm always happy to help or share my experiences with the type ones especially the type ones in my group, in my Facebook group, who either post a question in the group or reach me personally. I'm not a physician, I emphasize one of the first things I tell them, have your best friends by your side and your best friends are insulin, whichever way you deliver your insulin, and glucose tabs, you have to have glucose tabs by your side, because you don't know at one point, you're going to have a huge drop. And you may need those glucose tabs. But I support them. I don't know if that's important to mention here, but I don't I don't charge anything for that, and that can take quite a quite a big chunk in my day. I feel bad for having done or experienced something myself and not sharing it with someone who's reaching out to me. So, I'm saying it, amen, if you do think you can benefit from my guidance, or my five cents or two cents. Is it two cents or five cents?
Dr. Philip Ovadia 1:06:06
We don't know any more.
Nayiri Mississian 1:06:07
Feel free to reach out, I will do my best to help you. I also do coaching sessions to help people whether they're interested in weight loss or reversing insulin resistance, pre-diabetes, or even reversing type 2 diabetes, I've had clients have reverse their type 2 diabetes as well. With the help, I'm not a physician, with the help of their physician who was supportive and delighted that he was working with a coach. So, his physician helped him reduce his medication until he needed no more medication. And I was able to support him with his dietary sort of changes and giving him moral support.
Jack Heald 1:06:52
People are at this point are going, “how do I get a hold of her?”
Nayiri Mississian 1:06:59
Okay, so well I'm on Twitter under NTS translation. And I created my account when I set up my translation company. I'm on YouTube, or we have a YouTube channel Low Carb and Fasting. That's the name of the channel. Low Carb and Fasting is also on Instagram, has a Facebook page, we have a Telegram channel as well. And we have 2 Facebook groups, one for specifically Middle Eastern audience. Because having grown up in the Middle East, I thought that some of these messages are in going through to some of the people that I really would like to reach. And so, I set up a group specifically for my audiences because I was familiar with what they like to do, how they like to live, what they like to eat. So that's why I created a group specifically for that audience and another Facebook group specifically for type 1 diabetics who are doing keto and fasting,
Jack Heald 1:08:07
Or interested in learning how to do keto and how to do fasting. All right, well, I just I'll remind our listeners that all that contact information will be available in the show notes so you don't have to remember it. Just check out the show notes. And it'll all be there. Phil, for those of us who are... For those who are watching, you see that Phil's image has disappeared. But we still have him with us on the audio track. Anything else before we close up shop for the day?
Dr. Philip Ovadia 1:08:39
No, I just want to thank Nayiri for sharing her amazing story. I'm sure people are going to get hope and empowerment from her journey. And ultimately that's what we started this podcast for is to give people hope and to empower them to take control of their health. And Nayiri is just a shining example of that.
Nayiri Mississian 1:09:04
Thank you very much for inviting me.
Jack Heald 1:09:07
It's been a pleasure, you’re a light and your energy and your obvious good health are quite inspirational. I appreciate it. Well, it's always an honor to get to speak to folks like you. I'm grateful to be here. I want to remind our listeners you can follow Dr. Ovadia on Twitter @ifixhearts that's probably the best way to follow him and go to his website ifixhearts.co to take his metabolic health quiz. That's a real good way to start yourself down the road to getting metabolically healthy. For Philip Ovadia and our guests now Nayiri Mississian, I'm Jack Heald. This is the Stay Off My Operating Table podcast and we'll talk to you next time.