Resistance to plant food?

There is resistance to change in production and consumption of animal- and plant-based nutrition. Especially to the decreased intake of meat, fish and dairy. Why is that? And who will lead the change and explain the urgency? Or will we do it ourselves?

Sounds interesting? Then continue reading – it has developed into quite a long story, but if I have managed to put it down correctly it will change your life and lifestyle forever.

Being open to and managing personal lifestyle changes were in the centre of my previous posts; the first (change of insulin therapy) was top-down and the last one (change of diet) was bottom-up. As a follow-up, I here describe how a change in lifestyle can be perceived when it concerns the production and consumption of animals and plants, resulting in a lifestyle with less animal-based and more plant-based food: feel good with plant food.

Obviously, I have used my personal experience as described in blog 5, as well as my change-management-experience in the industry, and of course common sense! The common-sense approach is actually something you should always use, whatever you do or see!

Change management

You can find a lot about the topic in books and on the internet. Not surprisingly, because companies are continuously changing processes or reorganizing, especially those on competitive markets. A simple example: a leader, the Chief Executive Officer, the boss so to say, plans to change something within the organisation and starts to communicate a compelling story, for instance using the ‘look-because-so’ principles. Look, the clients and shareholders are unsatisfied, because our operating costs are too high, so we will make a change to work more efficiently.

Even the most successful changes have initially been met with any kind of resistance – ANY change ALWAYS elicits (some kind of) resistance. In preparing for a change it is vital to acknowledge resistance upfront and plan for actions how to deal with it. You can find quite some information on the internet about resistance to changes. I could, for instance, agree with Torsen Rick’s blog summarizing the most frequent/typical reasons for resistance to change.

I oppose the change because:

  1. I do not understand the need for the change
  2. I fear the unknown consequences of the change
  3. I do not know if I am capable to participate in the change – am I competent?
  4. I like to stick to the way we used to do it
  5. I do not believe the change will be managed properly
  6. I am afraid the change is another temporary fad
  7. My opinion has never been asked
  8. I have not been informed – poor communication
  9. I do not want to break my routine: I have been doing it like this forever
  10. I have had it with all changes
  11. The change will affect the status-quo, favouring others
  12. I do not know what the benefits and rewards will be

Because of the importance, once more: with ANY change you will ALWAYS have to expect and plan for the resistance of (groups of) people that will ALWAYS arise to some extent, for some time.

What kind of resistance should be expected to a drastic change in the production and consumption of livestock and plants, resulting in less animal-based and more plant-based nutrition?

1) The reason for the change is unclear:

As I have disclosed in the personal blogs (4 and 5), I started to understand the reasons why we should produce and consume less animal-based and more plant-based products – and a lot of people led the way before me. Still, it is only close to 1 percent of the world’s population that eats mainly plant-based or vegan.

“You can only see it when you get it”

Personally, it took 50 years to ‘see’ the reasons behind the change; once being open to it you find all kinds of information and ‘you get it’. What the consequences are of intensive animal agriculture for animal well-being, for the environment, and what the health benefits are of plant-based products compared to what meat, fish and dairy do to your body. At the end of this post, under ´Further Reading’ I have listed more extensively the reasons (including some website links). It only makes sense to read everything if you are open to it, or to say it like the Dutch (soccer) grandmaster, Johan Cruijff used to say: “you can only see it when you get it!” And I add to that, when you get it, you want to see that it stops or gets better:

  • less animal cruelty – in the Netherlands alone, we butcher over 500 million animals per year for consumption, which is 1.5 million per day!!;
  • recovery of the earth – animal agriculture is one of the largest contributors to the emission of greenhouse gases and causes of deforestation and ocean destruction;
  • a longer healthy life – plant food products contain all essential nutrients without the damaging effects of animal-based products (heart and vascular diseases, obesity, cancer, …).

Kip Andersen managed to give me a wake-up call pointing out the health aspects in his What The Health documentary, which made me see/realize/understand the other two reasons as well. Presentation obviously is really important. Who can wake up the Netherlands, who the world? Someone using a provocative approach? I wonder if one would give the change more thought when it would be presented by someone with the personality of for instance, Geert Wilders. He is a Dutch, right-wing politician, who is notorious for addressing sensitive topics, provoking the established administration.

It could sound like this (I have used ‘typical’ Geert Wilders’ expressions, which may be lost in translation):

Dear madam Speaker, it looks like this country has gone insane, yes truly insane! There are more pigs living in the Netherlands, in the province Brabant that is, than hardworking Dutchmen. These poor and intelligent four-legged creatures are crammed into stables so tight that their guts pop out their butts and are subsequently butchered. And for what, madam speaker? For dead meat, decaying in our bodies, with bacteria secreting toxins. For ‘meat-for-cheap’ exported to countries like Italy. Dear madam speaker, how can the prime minister sit there, do nothing and approve that the innocent, hardworking Brabant-folks are let down, yes literally let live with the stink?

Or someone with a totally different personality, Barack Obama, more inspiring, in analogy to the victory speech in front of his home in Chicago in 2008:

Hello, Chicago. If there is anyone out there who still doubts that America is a place where all things are possible, who still wonders if the dream of our founders is alive in our time, who still questions the importance of a healthy life, living peacefully among each other, preserving this beautiful earth, its life-providing forests and the animals that habituate it, then tonight is your answer. I think about the times that we were told that we can’t change the way we treat the earth, the oceans, the fish and our livestock; that we can’t change our health and dietary habits: Yes we can!

2) Fear of the unknown

This might be the most important reason that people oppose an announced change. I would be scared too when a world-leader would announce, top-down, to reduce the number of livestock, to utilize agriculture merely for our own consumption and all in order to eat more plant-based food and less animal-based. Definitely when no detailed plan has been prepared listing all potential consequences and concomitant solutions. And there are many more consequences than simply summarizing the facts that

  • we shall all live healthier lives,
  • we shall save the planet after all, and
  • we will cause less cruelty to animals.

Just thinking about the world economics’ effects, for instance, will give you lots of concerns and headache. You can often hear activists (including my ‘hero’ Kip Andersen; WTH documentary) say not to understand that the government does not interfere, or that the industrial agriculture (meat, fish, dairy), pharma-companies, doctors and patients’ associations conspire to prevent their products and services to get a bad, unhealthy label, that funds will dry up, etc.

I find this and the fear not surprising at all and can understand it. It is quite a big deal! To give an example: consequently, the pig stables in the Netherlands (or the intensive piggeries in North Carolina, USA, to give another) will all be closed. Only a few small farmers remain, raising pigs a pig-worthy way to provide for the small remaining meat demand. Alternatives for this export product will have to be found, for the farmers concerned, the package companies, the transport companies, for treasury, etc. And this is only a small example, in a relative small country – just consider what this would mean worldwide! Concerns and headache. Big headache, don’t you agree?!

Like in many other countries, the Netherlands promotes milk: “milk, it does a body good”; well-intended and good for economics and the industry: in the fifties there was a surplus of milk, and the government granted subsidy for school milk. And to go into this example a little further, I am not surprised that the dairy industry sponsors studies demonstrating positive health effects of milk – it is part of marketing! One believes in the product. When someone else publishes negative results about it you make sure that there are positive results to be shown as well. On American websites I found interesting quotes relating to so-called checkoff programmes from the USDA (Unites States Department of Agriculture) promoting animal products: “incredible, edible egg”, “beef, it’s what’s for dinner”, or “pork, the other white meat”. Checkoff programs help to expand markets, increase demand and more. It all makes sense from an economics’ perspective.

The list of potential consequences is too long to capture in one blog. I do, however, wish to mention another more positive outcome. Consumption of more plant-based and less animal-based products will result in people living longer healthy lives. Yes, truly, I am convinced! The twenty years that may have been ‘taken’ from me when diagnosed with type I diabetes at the age of 15 (see blog 1) have been given back to me, now being on a plant-based diet. A hundred years, here I come! The demand for cholesterol lowering drugs, blood pressure medication, stents, and the like, will reduce significantly. And I am not just referring to diet-related diseases (like obesity, type II diabetes, cardiovascular diseases), but also to those with a genetic background. Many diseases are caused by mistakes/mutations in the hereditary material, DNA. But there are also so-called epi-genetic components to result in the ‘visible’ disease; epi-genetic components are for instance environmental factors, stress, diet, … I know that my type I diabetes is genetically predisposed; it might be possible that, as an epi-genetic factor, consumption of animal-based nutrition (especially dairy products are mentioned in connection with autoimmune diseases) has been involved. My immune system somehow has been prompted to develop antibodies against my own insulin and/or insulin-producing cells. Anyway, as a positive consequence of less demand for drugs for the currently common diseases, the pharmaceutical industry can focus more on other, rare (mainly hereditary) diseases.

3) Am I capable to participate in this change?; 4) connection to the old way; 9) Changing my routine?: I have been doing it like this for ever

Of course, (almost) everybody has routine, also with respect to shopping, cooking, eating and exercise. Without proper coaching many people will fail to successfully change their diet. There are many countries (the USA for instance) where as a daily routine ‘ready-to-eat-meals’ are on the menu. Processed and often full of animal-based ingredients. Just to be clear, putting such instant meals, TV dinners, in the microwave or oven is not cooking. Not in my world. Plant-based dishes are best when prepared fresh and cooked in the home. Not everybody will be comfortable to change to such a new regime.

When, as a child, I would ask what’s for dinner, then always the meat was mentioned first: “Pork-chops!” And what else? “Potatoes and cauliflower” And for desert? “Yoghurt and fresh fruit.” At lunch my parents drink a glass of milk, every day, and so did my grandparents, and their parents and grandparents, etc. This is how we always did it. We all learned it at our mother’s knee, or more literally, we took it with our mother’s milk; school milk is still being sponsored. This is not something you easily let go of. I can understand the resistance!

For dinner? Me?

Consumption of meat, fish and dairy is a tradition; that tradition and common sense can be two separate topics is demonstrated in the next example. In certain Asian countries the meat of dogs, our favourite pets, is on the menu. Something that is beyond our comprehension and seems to make no (common) sense at all. Still, it is tradition.

When you keep doing what you always did, you will keep getting what you always got.” This expression is relevant when trying to overcome resistance against change because of routine. Not changing means that we will keep consuming mainly animal products, that we keep being dependent on intensive animal farming, that we keep increasing our impact on the environment, and that we stay on course to destroy the earth … This course is quite scary: with the ongoing increase of prosperity in countries where normally a lot of plant-based food was consumed, the adoption to a more western diet, mainly based on animal products will increase as well. In case all Chinese would adopt the animal-based diet of the Americans then the earth is too small to house all cattle and have sufficient farm land to grow grains to feed all animals.

5) Low trust in the leader managing the change

Who would be capable of leading such a drastic change? Someone above the world? And management of the change would have to happen per country – by the relevant presidents? I watched a short interview of the ‘health-and-environmental-activist’ Leonardo DiCaprio with the president at the time, Barack Obama, discussing climate change due to greenhouse gases; his performance was okay, but not really specific. Obama, no longer in office, could or may want to do it. He has the trust of many, within and outside the US – for sure he is ‘world-minded’ and less ‘America first’.

6) The change is a temporary fad, a hype; 10) the umpteenth change

I found an interesting blog from foodrevolution on the topic whether or not plant food is a hype. It is important to explain that less consumption of animal food is not a hype, is not temporary, but a sustainable solution. It is not the umpteenth change like: “First I had to eat more fish, and now less” or “First I had to watch my carbs, and now animal proteins and fat”. So, important to explain that omega-3 fatty acids were the reason for recommending fish in the first place – I still recommend these fatty acids, but then from plant origin. Remember, also in the new plant diet, fat is fat, so eat with moderation, even when it’s the good kind: fat from avocado and nuts, for instance, is still fat and therefore high-caloric: “don’t go nuts on the nuts!”

Well-intended campaigns like ‘meatless-one-day-a-week’, ‘meatless Monday’ or ‘world meat free day’ run the risk of being considered hypes. Every little bit counts. But it detracts from the seriousness and urgency of the change. People that stick to these campaigns for a while really think they are doing something good. Short-lived and delay of execution; even in the best case scenario that all meat-eaters would refrain from it one day a week, then the problem still keeps growing: in ‘relatively poor’ countries the intake of animal-based nutrition (meat) is growing along with growing prosperity. Consumption of meat, fish and dairy should no longer be the norm, that’s what needs to be emphasized! Therefore, the ‘meat, only-one-day-a-week’ campaign, instead.

7) I was never consulted; 8) poor communication

No such thing as too much communication – often too little is being communicated, too few (groups of) people involved, too little explanations given, too little information about progress of the change-management-process. What is the input of the companies affected by the change? The scientists, the activists, …? All stakeholders, there are many! All of them need to be involved and participate in the change. Not an easy task. Again, more concerns and headache!

11) the change will favour others; 12) the benefits are unclear

The change will not benefit the industry, all companies involved, directly or indirectly, in animal-based nutrition; those involved in horticulture and production of plant-based nutrition most likely will. Not easy, but upfront it should be figured out what the first group will do and what support will be offered. These stakeholders should be involved in the change-management process. Once more, not an easy task to organize.

“You can claim that animal-based nutrition is bad for your health, and increases the risk of cardiovascular disease, but I have also seen different reports…” Who or which study report should you believe? As scientist I think I can distinguish between well-set-up, well-executed studies and those with a more biased design – especially when such a study is being sponsored by the meat or dairy industry, for instance. Still, even thinking of the discussions around smoking, with an evident causal relationship with diseases like lung cancer, it took many years before it was required by law to label cigarette packs with notices of health effects. The tobacco industry has promoted (also through studies) smoking, claiming it would not affect your health.

I like to think that it should be much easier to stop or reduce consuming animal food than to give up smoking – cigarettes contain highly addictive compounds and after stopping you will go through withdrawal. Consumption of meat, fish and dairy is more a matter of habit, an acquired one; it is only cheese that contains casein that may elicit addictive responses. In all honesty, it is cheese, Dutch cheese, the old one, that I still have some craving for. Especially on Friday afternoons enjoying a beer, now with nuts on the side instead of a cheese plate.

All the same, of the three significant consequences of a change to a more plant-based and less animal-based diet, the effect on your health should be the most tangible reward; less animal cruelty and less greenhouse gases (and manure/stink) can easily be overseen, especially when you choose to stick your head in the sand.

 

Conclusions: we, the consumers, are going to lead and implement the change

My first conclusion: this change will not be led top-down.

Considering all above-mentioned resistance and potential (concerning and headache) consequences, especially those affecting economics: NO world leader will stand up to sit with the countries’ leaders and roll out a plan to reduce the intensive animal farming (including fish farming and fishing), to advise against consumption of meat, fish and dairy. Not Obama. Maybe when he feels empowered by the people, and the proportion of ‘green’ consumers quickly has risen to let’s say 50% (this is discussed below, under ‘what is your role?’). What also won’t happen is that the leader of a single country, like the Netherlands, will implement this change before the others do. Would be unwise – the urgency concerns the planet, the earth: all countries, all people need to get involved, not step-by-step. For comparison, it would be like Theresa May, the prime-minister of the United Kingdom, exclaiming one day: look, there is a problem in our transport branch; because, in almost the entire world the right side of the road is being used, while we drive on the left side; so, we shall use a step-by-step approach to drive on the right-hand side – trucks start tomorrow, cars next month, … Similarly, premier Rutte will encounter quite a few ‘collisions’ when he announces that the Netherlands unilaterally will stop the export of pork, without the other countries embracing this idea. Everybody needs to be on board for a change to be successful.

My second conclusion: this change will be a success when led bottom-up

POWER TO THE PEOPLE! We, consumers, have the power! More demand for plant foods and a decreasing one for animal foods will determine the supply. Consequently, the industry will follow the dollar, without any resistance. Comparing diet to music. We don’t just like to eat, we love to listen to music, and often at the same time. Don’t we?

Years ago, we could choose between long-playing records (LPs) and digital music. An increasing number of people chose digital music over the LP, and a new market developed for streaming services, phones with music gadgets and many more devices and services. We, the consumers, have caused this change – there was no-one who led this top-down; no-one said we should refrain from listening to LPs or use digital music. We simply realized it according to the economics’ rules of demand and supply. Without resistance, not even from the producers of LPs. Listening to digital music is currently the standard, and only a few still listen to LPs.

And in the same way plant-based nutrition should become the standard, animal-based the exception.

What is your role?

Be the leader of your own lifestyle change. Start the experiment tomorrow, like I did and described (blog 5), first of all for your own health. During that time, you will start to dig some more into the subject. Not in the least because you will surf the internet to find recipes how to enjoy plant food. Yes, really this is possible! You will rapidly increase your knowledge, not just of health effects, but also of the wrongs of intensive animal agriculture. I can almost guarantee it that you will say more than once: but that’s insane?! That cannot be true! What the hell are we doing?!! This is exactly what happened to me during the two-week-no-animal-food experiment. The experiment was concluded some 4 months ago, and I still hardly eat any animal-based food.

I really think the same will happen to you. The next step is to have others follow in your footsteps. This can be a fun process. When asked about my abstinence from meat, fish and dairy, my first response is that I do it for my own health. And that I will not try to convince others, uninvited, like a Jehovah’s Witness. Every time, sometimes immediately, other times the next day or the next week, the question is being asked: “can you tell me more about it?” Then they are on the hook and I start telling more. The health aspect is in my experience a very appealing way to continue the discussion.

Just another day in paradise

My fiancé and I got married early June and went on our honeymoon to the Dutch Caribbean island, Bonaire. SCBA diving and enjoying the Caribbean atmosphere and each other, of course. We met a nice couple, shared a few drinks and spoke about all kind of things. At their homecoming they started eating plant-based, having received our help with a shopping-list. I have more examples like these, and I call on everyone reading this to participate. You can do the math and calculate how many people change their diet to a mainly plant-based one, in case every participant manages to inspire three others within two months. Within a year, theoretically, more than half of the world’s population could have changed the dietary lifestyle. Ruud, from the couple at Bonaire, called this the pyramid-scheme-principle.

A matter of action

Hummus, grilled vegetables, and more

So, ready for action?

Convince yourself first as described above. Then start speaking with the people with whom you already have a relationship of trust.

Point out that more plant-based and less-animal based nutrition is good for you – preferably with examples if you have any (you lost weight, your arthritic pain sensation reduced, you feel more energetic, …).

Next, that it would also be good for him or her, and that more and more people are doing it.

Finally, admit that the beginning might be hard, but that you managed and that he or she is destined to succeed as well – direct to websites or send a shopping list with plant-based products or something to provide support.

And don’t forget to prepare a delicious plant-based lunch or serve plant-based snacks when friends are coming over to your place.

TO CONCLUDE

SHARE this post, this message with as many people possible. Twitter, email or trough whatever medium. Share buttons can be found at the bottom of this post, under ‘further reading’.

We, all of us together, will make it happen! Feel good with plant food. Change. Yes we can!



FURTHER READING

 

Reasons for change

There are three (groups of) reasons to produce and consume less animal-based nutrition, without claiming to be exhaustive:

1) Animal cruelty

  • In the Netherlands more than 500 million animals are butchered a year
  • There is a short video with horrific numbers (you can skip the Dutch narratives): around 30 hogs, 3 calves, 1 cow, 1 lamb and no less than 1100 hens – per MINUTE that is …
  • More about pigs as an example for the Netherlands:
    • 30 million piglets are born every year, of which 5 million die within the first weeks because of the ‘not-so-nice-circumstances’
    • more than half a million adult pigs die because of the ‘not-so-nice-circumstances’

there is a lot you can find about animal welfare/cruelty concerning the animal farming, for instance by PETA publishing on abuse in the meat and dairy industry or on the egg industry.

2) Environment

The fossil fuels (oil, natural gas, and coal) and the industrial processes are the largest causes of increasing CO2-levels in the atmosphere. Animal agriculture is a solid second (numbers are always subject to discussion, but it could well be around 21% and on the rise). Fortunately, oceans and plants absorb large quantities of CO2 and, to some extent, make up for the emissions, provided that we don’t destroy the oceans and tropical rainforests by intensive fish and cattle farming, respectively. It is great for the environment to switch cars and start driving electrically. Yet not many seem to realize that an even higher impact can be obtained by reducing the consumption of animal products, since the greenhouse gases caused by animal agriculture exceed those of the entire transportation sector!

The Guardian wrote in May 2018: “A vegan diet is probably the single biggest way to reduce your impact on planet Earth, not just greenhouse gases, but global acidification, eutrophication, land use and water use,” said Joseph Poore, at the University of Oxford, UK, who led the research. “It is far bigger than cutting down on your flights or buying an electric car,” he said, “as these only cut greenhouse gas emissions.”

The reason for chopping down the tropical rainforest (Amazon) is agriculture growing grains to feed livestock! It’s a two-edged sword, because the rainforest can still save us, nut merely by providing oxygen, but also, like mentioned before, by absorbing CO2. Animal agriculture equals an increase in CO2 emission and a decrease in forests. And then there are the oceans to still save us – sadly, also these are being destroyed, simply by over-fishing (caused by too high a demand!), ocean dead zones (read about the role of animal agriculture), pollution and habitat destruction.

3) Health

Almost everybody agrees that plant-based nutrition is very healthy, albeit, as mentioned in my earlier blog 5, that even vegans can have an unhealthy diet. Daily consumption of French fries with processed soy burgers and a coke, to give an example. A diet consisting of lots of vegetables, fruit, beans, legume, potatoes, wholegrain rice and pasta will give you all nutrients your body needs. There is only one vitamin that you need to supplement. Vitamin B12 (from bacterial origin; still present in meat). Consuming meat, fish and dairy will give you lots of nutrients, and … and more. A lot more. Cholesterol, saturated fatty acids and animal proteins. Scientists seem to have reached agreement on red meat, increasing the risks to develop cancer, cardiovascular disease, … For the other animal products similar risks apply, despite the industry’s efforts to protect its market – understandably. In one of the documentaries I heard a doctor say to the question “should I eat red meat or white meat?”: “it depends, do you want to get shot or be hung?”

Cold water fish is rich in healthy omega-3 fatty acids, but you can also obtain these from plants (this is actually what the fish do): algae, hemp seeds, linseed, … without the intake of the saturated fatty acids and cholesterol from the fish. Plant-based food contains ZERO cholesterol (your liver will make it for you). More about health effects of farm-raised fish and wild sea fish: 4 reasons seafood isn’t as healthy as you think, and don’t take the bait fish is not a healthy food.

Milk

In the animal kingdom milk is only consumed by babies; the Netherlands with some other countries are the exception were tradition has it to drink milk after weaning. Cow’s milk. Strange! Foreign! Therefore, increased risk that the body’s immune system responds with antibodies and inflammation. You can read more about Why do Animal Products Cause Inflammation?

Vegan and numbers:

In my search for more information about the number of people with a lifestyle with mainly plant-based nutrition, beside above article, I came across an article by Dan Hancox, posted in The Guardian: ‘The unstoppable rise of veganism: how a fringe movement went mainstream’. Worth reading!

It is difficult to come to a reliable number of people, worldwide, that fully or largely comply to a plant-based diet. Surveys are not being done in all countries. The questions are not all the same. The sample size varies and so does the confidence of the outcomes. What is evident is that the number of people interested in plant food and the number of vegans has clearly increased over the last years. A rough estimate of 1% people worldwide that mainly stick to a plant-diet, means that approximately 70 million (world population about 7.6 billion) people are on the right, green track. Theoretically, it should be feasible to change the lifestyle of half of the world’s population quite rapidly.

Let’s say that half of the current green people (35 million) each convince three people to consume more plant and less animal-based food within 2 months, and the new converters do the same, et cetera. The increase takes huge leaps because every cycle has a multiplication factor of 3: starting with a single person means to obtain more than a 1000 green people after six cycles: 1 –> 3 –> 9 –> 27 –> 81 –> 243 –> 729 (sum = 1093); after 19-20 cycles around 5 billion. Even faster when you start with a large group: 35 million –> 105 million –> 315 million –> 945 million –> 2835 million: after 4 cycles 4 billion people will have been convinced to change.

The prelude:

In my fourth blog I wrote about the sudden recognition of the issues accompanying my (and almost the entire world population’s) behaviour concerning consumption: dairy, meat and fish – I want, ‘of course’, these products to be 1) tasty, 2) everyday available, and 3) cheap!

Somewhere, sometime, I must have heard that my 3 ‘demands’ are disastrous for the earth and the animals (cattle and poultry breeding), but I never gave it much thought.

Because small farmers cannot provide ‘cheap’ and ‘everyday’ products, they have been and still are being replaced by mega-stables. Such stables consist of genetically identical animals, prodigy of one father selected for ‘good taste’. All thousands of animals are equally ‘tasty’ and at the same time equally susceptible to diseases. Therefore antibiotics! Lots of it, mega-lots of it!

Because I, the consumer, want to go shopping at the most inexpensive supermarket, the suppliers are being pushed to reduce prices. Therefore, focus shifts from quality to quantity. I can also imagine that this accelerated production does not really benefit the welfare of chickens, pigs and cows. Besides that, the production of animal products apparently is so inefficient, requires so much water, takes away so much forest to allow for growth of feed for cattle, emits such a high quantity of greenhouse gases, that I feel ashamed that I have not taken any of this into more thoughtful consideration.

As mentioned in the previous post, after having watched the documentary “what the health”, I started to do some more research and read about the positive effects of plant-based nutrition and the (potentially) harmful health effects of animal-based nutrition. I take it for granted that Kip Andersen now and then runs with favourable scientific results, exaggerates – he appears to be the first one to make me realize that how we treat the earth, the animals and our own health is unsustainable! I like to think that many people support the concept of ‘less animal and more plant-based’, but that only a few really act on it, because people may think it is not easy to accomplish, because it puts you in a place outside the generally accepted lifestyle, and I am sure there are more reasons (or excuses). For me personally, it has been the health effect that made me decide to do the experiment of not consuming any animal-based nutrition but live on a plant-based diet for two weeks. My fiancé fortunately joined me in the experiment.

The experiment: no animal-based nutrition for 2 weeks

And this is how it went. First to the supermarket. It was striking that more than 95% of the food products are animal or animal-based. Having to read all package labels to check for animal-ingredients also gave me a sense of all the stuff that is being added to processed food. Not very healthy, and not very easy to find fully plant-based products. It did not stop us, though. For base-storage we bought:

For breakfast:

oatmeal, (frozen) fruit, chia-seeds, soy/almond-yoghurt and -milk and linseed oil.

For lunch:

wholemeal bread, rice crackers, plant-based margarine, peanut butter, bittersweet chocolate sprinkles, apple spread, jam, chickpeas, tahini, lemon (self-made houmous), avocados.

For dinner:

potatoes, sweet potatoes, wholegrain pastas, wholegrain rice, black beans, kidney beans, marrowfat peas, chickpeas and lentils. Furthermore, lots of vegetables, fresh and some canned (tomato-chunks for instance), onions, garlic, hot peppers, coconut milk, tomato purée, canned and fresh spices (parsley and coriander for instance) and olive oil.

For snacks:

Lot’s of fruit and unsalted nuts to go with soda light, the beer, water or the glass of wine; crisps were purchased as well: they are plant-based but very salty and fat so not very healthy (it is true, you can be an unhealthy vegan, if you wish, living on cola and crisps for instance); bittersweet chocolate.

Next stop at the bio-shop to experience what kind of soy products and other meat-substitutes are available, to bring some bite to the dinner dish like soy-burgers, vegan-sausages and the like. Also available were all kind of vegan sandwich fillings. We realized of course that as is true for all processed food products, besides plant-based nutrition you can take in lots of undesired additives (E-numbers, but also salt, sugar and the like). It probably still trumps processed animal-based products.

At the chemist’s we finally purchased vitamin B12 pills, crucial to one’s nervous system and blood. I had heard and read that this vitamin is produced by bacteria and is still present in animal-based products, but when eating a fully plant-based diet one should supplement it.

With my scientific background and experience in large-scale research studies I knew of course that my experiment was not flawless, to put it mildly. An N-of-one experiment, so to say, cannot be used to demonstrate a scientifically relevant effect; for that you would need great numbers (n stands for number). Moreover, it is essential to not have too many variables, because you would not know which is responsible for the potential effect. In my experiment with an n=2 there were many variables. To name a few, I had switched to my new insulin therapy only a few weeks earlier (see blog 3) and we had relocated from the inland (Austria) to the coast (Germany). The potential effect that the new plant-based diet would have on my blood sugar, my blood pressure, or on the pollen allergy (hay fever) of my fiancé could therefore also be explained by the other variables. Nevertheless, it was foremost a personal experiment, meant to convince just me.

I then remembered the claim that inflammation would no longer be promoted when stopping with consumption of animal products but would rather be prevented; many years of basketball, tennis and other sports, have led to a damaged right shoulder, kind of chronically inflamed, with flares when I exercise too hard in the gym. I quit playing basketball and tennis already years ago. In the gym I do my exercises at low intensity, and I do breast and shoulder presses to a minimum. This prompted the idea for a suitable outcome of my personal experiment: what does my shoulder feel like when I start doing push-ups again?

The result:

To come straight out with it, we are still eating plant-based food, approximately 4 months after the 2-weeks’ experiment. Initially afraid to start having craving for certain food products, this did not really happen; instead, I learned to appreciate many new ingredients. When visiting friends or family I will join and eat whatever is being served, so now and then I still eat animal-based nutrition. But in all honesty, I would not in a million years have imagined that I would be writing this: I do neither miss the steak, nor the grilled chicken, the meatball nor the boiled egg – and I reaaaally liked those very much. Apparently, after a few months (2 weeks is actually too short) my body has been deprogrammed, the cells of my body have built in the healthy fatty acids, proteins and all the other plant-derived stuff, my intestinal flora has been reinvented to help digest plant products ….

My recently assessed HbA1c value was 5.7% and my blood pressure has never been so low so I may need to consider to reduce my dose of candesartan (drug to lower blood pressure) – see also blogs 2 and 3). The LDL (‘bad’ cholesterol) value was ridiculously low: 2.19 mmol/l (normal range 2.60-3.40) with a value of the combined cholesterol being 4.11 (normal <5.2). The hay fever attacks of my fiancé stayed away for quite some time but came nevertheless – to a lesser extent, she claims; besides that, the constipation that troubled her more often than she likes to admit, disappeared completely. The new intestinal flora apparently knows how to deal with plant-based nutrition!

Push-ups, ranging from 1 to 3 sets of 30 reps give me no trouble at all. At some point I accepted the challenge, after a 4-5 years’ break from the game, to play tennis with my neighbour. After the exercises, the next day, I have a sensation in my shoulder, but the pain is not sharp and seems to be kept in the background.

Tentative conclusion:

Nutrition or nutraceuticals, in my personal opinion, are not to be considered drugs and cannot heal my damaged shoulder. What plant-based dietary products can do, I think, is to prevent inflammation and to increase cell function and susceptibility to drugs. Leaving processed meat-replacement products and snacks out of the equation, your body receives merely healthy components on a plant-based diet: only small amounts of saturated fatty acids (and hard unsaturated fatty acids), no cholesterol (really, no, meaning ZERO!), many fibres, vitamins and minerals. Physically I feel fine and I am confident I get all the required/recommended nutrients. In fact, I am surer now compared to the time when I had meat, fish and dairy in my diet. On top of that I have eased my conscience by consuming less animal and more plant-based products – it is a very good feeling knowing that my current lifestyle does not impact the environment and animal welfare as much compared to a lifestyle including animal-based nutrition.

Writing this blog has had an enormous impact on me, with the accompanying question why it obviously has been so difficult for me to be open to this change of my lifestyle.

I wonder if others, just like me, need some kind of extra push to consider an experiment like the one I just described? It cannot really hurt now, can it?

Please don’t hesitate to post a message in case you would like to receive more tips or ‘pushes’.


 

FURTHER READING

 

Frequently asked question:

Do you get sufficient dietary intake of calcium and proteins when leaving out animal-based products? These kinds of questions are frequently asked when telling people that you are on a fully plant-based diet. The first thing that comes to mind, without saying it out loud, is whether the carnivorous person asking this question, gets sufficient amounts of fibres, vitamins, minerals, and unsaturated fatty acids with his or her diet? But back to calcium and proteins: milk indeed contains calcium, and milk, meat and fist indeed contain proteins – but you can easily obtain calcium and proteins from plant sources WITHOUT the superabundance of saturated fat and cholesterol. There are many books and online publications on plant-based diets. I would be happy to recommend you a wonderful book I read, but unfortunately it has not been translated into English. Miranda Hammer in the US, I found online, has some interesting topics on her website about plant-based diets.

Cholesterol:

There is no need for dietary cholesterol since the liver produces the required amount (building block for cells and hormones). The equilibrium between the level of cholesterol in your blood and what the liver produces can be disturbed, by your lifestyle among others – consuming lots of fatty acids for instance; (poly) unsaturated fatty acids have a rather positive effect on your cholesterol levels.

In my third blog I have written about my recent switch to another insulin therapy. The blog left me with the question why, after 35 years of being a reasonably successful diabetic, I all of a sudden was open to change.

In this post I will disclose another recent change concerning nutrition and diet to which, again all of a sudden, I seemed to be open. Arguments have been around for quite some time, but I was listening only now…

What the hell, what the health:

And this is how it went. My fiancé was away for a few days, to Munich. In the evening, I sat down on the couch with the other ‘men’, our Siamese tomcat and our dachshund he-man, watching an action-hero movie on Netflix. Beer at hand, a few actually, with cheese cubes from the Netherlands delivered by my parents who had come to visit some weeks earlier. Delicious!

I am sure it must have been entertaining, but not more than that, because I don’t seem to remember the name of the movie. I do remember deciding to stay up and watch something more peaceful before hitting the sack. In my Netflix list there still was a documentary I had saved about nutrition, “what the health”. My fiancé had stopped eating meat quite some time ago, and I started eating more fish and less meat, since we shared a house. That’s how things go, of course.

I was expecting that the documentary would recommend fish over meat or something like that. Maybe I did not think that much anymore, late in the evening and having drunk all those beers – beer in Germany is sold in half litre quantities.

After the first ten minutes I though about going to bed; initially, it seemed as if the documentary wanted to sell plant-based/vegan nutrition as medicine. In the early days of my career I have been involved in research into potential health effects of nutritious compounds (nutraceuticals), and I became convinced that they cannot replace drugs.

Still, I kept watching. Kip Andersen and Keegan Kuhn (with Leonardo Dicaprio, as the producer for Netflix) tried to sell us two old topics, and one – to me, that is – very new one.

  1. Animal agriculture has a disastrous impact on the environment – I am sure I had heard this before, but I obviously did not care enough;
  2. Animal agriculture, especially on a ‘mega-scale’ leads to animal cruelty – again, I had heard this before, but I must have looked away;
  3. Consumption of animal products is unnatural and harmful for one’s health, whereas a plant-based diet prevents heart disease and reduces the incidence of diabetes and cancer ….

Several Americans, with all kind of health issues, were interviewed and claimed to have gotten rid of or have reduced their medication after two weeks on a merely plant-based diet.

Still that same night I sent a text message to my girl friend to announce my two-week experiment….. She said to take part and she thought I was drunk.

I still wonder why I was open to this change, at this stage, why did I listen now to what I must have heard before.

On the internet, I discovered quite some feedback about the documentary. Positive comments, but definitely also negative ones. Kip Andersen was exaggerating, cherry-picking, providing a platform for prejudiced doctors, etc.

Personally, I consider presentation crucial when communicating a mind-blowing message to promote a change. Exaggeration is allowed, in my opinion, in order to bring the message home. I remember that I saw Jamie Oliver on TED-talks pushing a barrow filled with sugar and emptying it on the podium – this is the amount of sugar that children are consuming in England at elementary school; for the US he filled an entire school bus with sugar. Slam dunk! Message delivered! He followed-up with a plan how to change this.

Even if only half of what was presented would be true, then still this is worth considering. I realize only now that each of the three topics on its own suffices to, what I call, consume ‘less animal and more plant-based’ food products.

So why am I only listening now, this late??

It is a very interesting and important topic, but thinking about it makes me a bit sad at the same time. Because I, and with me most of us, daily demand animal meat or animal-based or -derived products for consumption – with the best taste, at low cost – more and more mega-stables have been built housing genetically identical livestock (all with the same father). The animals all deliver products of similar taste, but they are all equally susceptible to disease. And the diseases, subsequently, can be introduced into humans (AIDS, Q-fever and encephalitis are just a few examples).

In all honestly, I have never really listened to animal rights activists like Marianne Thieme. She is heading up a political party in the Netherlands called ‘Party for Animals’ (a quick surf on the internet taught me: UK: Animal Welfare Party; US: the Humane Party and the Animal Rights Party USA) . For the purpose of this post I took the opportunity to read the party’s program and it actually accurately describes the first two aforementioned topics. So why did I never listen to her. Perhaps that the name, ‘Party for animals’, does not appeal to me – foremost it is the environment (and health) for humans that will significantly improve upon reducing the number of livestock for consumption. Less deforestation (now: 80% deforestation amazon rainforest), less greenhouse gas/CO2 emission (now: 15% caused by livestock), less use of antibiotics, less resistant bacteria/viruses, less water consumption (now: a quarter of world water consumption is used for raising cattle), less pollution salt and sweet water, … all good for us, humans. So, let’s rename, ‘Party for People’, right Marianne Thieme?

It is interesting and peculiar, that I started thinking about this, only after my 50th birthday, and am willing to change my lifestyle. It must have been the third topic, animal products not being so healthy, that is close to me, is about my health, can potentially influence my diabetes, …. A very selfish motive actually! I know, of course, that to achieve changes, you should communicate tailor-made messages targeting a specific person or group. Apparently, listing numbers of CO2-emission and acres of cleared rainforests because of animal agriculture has not worked for me, initially. Kip Andersen’s documentary ‘what the health’ and its slightly exaggerated health effects did manage to let me think about a ‘more plant-based and less animal-based’ diet.

In my next post I will inform you about my lifestyle-change-experiment and share my experience after 2 weeks on an exclusively plant-based diet.

 


 

FURTHER READING

Kip Andersen and Keegan Kuhn directed two documentaries leading to my post above: Cowspiracy and What the health.

 

The movie WTH received quite some criticism about exaggeration and the use of numbers that fit the vegan picture. Like the reference to a single study that showed that animal agriculture is responsible for 51% of global CO2-emission. General consensus is that this industry is responsible for 15%: also quite a high number!! Disturbingly high, actually.

In my second blog I have covered some of my personal memories of the 35-year period using an insulin mix of short and long-acting insulin. In this third blog I will tell you about a more recent and impactful change. The switch to another insulin therapy, also changing my lifestyle.

A modern diabetic after all

Upon my relocation from Austria to Germany in 2017, again I soon was on the look out for a general practitioner to subscribe my medication Novomix and Candesartan (blood pressure drug), pen needles and test strips. In all honesty, I used to be under the care of an internist for a relatively short period after my diagnosis. After my first relocation (away from my place of birth) I have always had general practitioners for the HbA1c assessments and for the prescriptions. In my previous blogs I have told you about my disciplined life on 2 daily injections and 6 meals. 35 years, with sporadic searches for potential new developments in diabetes treatments. In Vienna I had a fellow-diabetic in my team, who, in my opinion, tested her glucose level quite often and gave an extra injection as a result of it. She would join the rest of the team eating cake that was brought in by another colleague, whereas I would always say ‘thank you, but no thanks’.

The assistant of the targeted general practitioner in Germany (conveniently close in the same street!) informed me that the practice did no longer accept new patients. I did not want to leave without a ‘fight’ and started a friendly chat about how difficult it is to find your way having moved from abroad and that my search for a doctor was on the top of my list. She started apologizing and mentioned that the practice had specialized on treating diabetes patients, …. Bingo! And maybe she was a bit resentful, but she could not refuse diabetics, and for the first time in a very long time I had an appointment with a diabetes-expert.

After two weeks, holding the letters from my Austrian practitioner (list of HbA1c values and medication I was on), I was first examined by a nurse. Potential nerve damage was assessed with a feather tickling my feet: all was fine! HbA1c was determined on the spot using a finger prick test – thusfar I was used to giving up a vial of blood to be sent to the laboratory for analysis. The result was 5.8%. Excellent! Weight 85 kg – also fine with my 6’4 height. Blood pressure was despite my medication (Candesartan) somewhat high: 160/110. In the morning I had had a rather unpleasant conversation with my supervisor; after only a few weeks I was sad to realize that the company culture was not like what I had anticipated – maybe that had resulted in elevated blood pressure values.

At the doctor’s I was asked to handover my glucose meter (OneTouchVario), which he connected to his computer. He mainly observed relatively high and low values – I tried to explain that I do not test at regular intervals but tend to only test when I suspect either high or low blood sugar levels. He then wanted me to prepare day curves over the next weeks, testing every 2 hours, and writing down how many bread units I consumed during the day. He sent me home and to consider a new insulin therapy, more contemporary and not as old-fashioned to only use mixed insulin.

Two weeks thereafter back at the doctor’s the curves looked reasonable well, including the registered meals and carbohydrates transferred into Bus (bread units: 1 BU = 10 grams carbohydrates). From the still significant number of low glucose values he concluded that I would have had more and lower values in case I had not consumed additional food – I explained that for 3 years I was used to eat in-between-meals/snacks. Personally, my lesson was that frequently testing blood sugar helped me to prevent too low levels; in that respect I agreed with the doctor that I used the tool food to compensate. He went on to tell me that, though a relatively well-established diabetic, nowadays most diabetics are treated with two types of insulin. One injection with long-acting insulin and several injections with short-acting, depending on how often you eat and what. He asked me to consider (I am sure he had been attending a “change-management-course”), but I immediately agreed. The only thing I proposed is to start if and when I could monitor my blood glucose continuously without having to damage my fingers; the previous year I had, at my own expense, tried the FreeStyleLibre sensor from Abbott. I still had the reader so I only needed to order a few sensors for this experiment. And then it started.

With the arrival of the sensors, the doctor prescribed Toujeo as the long-acting and Fiasp as the short-acting insulin. We had some debate about the tie of the Toujeo injection, because the doctor preferred injection in the evening in the belly area, always at the same time. My preference is to have this injection in the morning in the upper leg; it was akay. I planned to use the belly skin for the Fiasp injections. He also prescribed pen needles, much shorter than the 8 mm that I was used to. The 4 mm needles would allow for 90-degree angle injections into the skin, whereas with the 8 mm needles I had been used to 45-degree angle injections into a fold of skin and use a cotton swab when pulling out. Wow, this would take some time getting used to!

The change was and still is enormous! The doctor had given me an initial scheme with a fixed dose of Toujeo and several different doses of Fiasp depending on what he called the bread-unit-factor (BUF). During the first two weeks, using the FreeStyleLibre measurements, I have been having quite a few correction injections, but with the new 4 mm needles that was no problem for me at all.

I finally nailed the dose of Toujeo refraining from food and Fiasp injections after the morning injection. I am currently using 14 units that ensures my blood sugar to be in a steady state, day and night.

Having switched from 6 meals at regular times to 3 (relatively larger) meals I no longer have to stick to a schedule. Depending on the blood sugar values I inject Fiasp; with values between 5 and 8 mmol/l there is no correction required and I inject 1 unit for every bread unit I plan to eat; this so-called BUF may differ per person and over the day. In case of values >8 I add a correction-dose in order to bring the value down to 7: 1 unit to reduce 2 mmol/l. For example, I eat 5 sandwiches (5 BU) and the meter indicates a value of 11 mmol/l (200 mg/ml) then I calculate: to bring the value down from 11 to 7 mmol/l it needs to reduce with 4 mmol/l for which I need 2 units; for the 5 sandwiches I need, with my BUF (of 1) 5 units: I therefore inject 7 units in total right before this meal.

What a difference when compared to how I dealt with this before – I simply would not eat with a blood sugar of 11.

In case the meter shows a value below 5 mmol/l (90 mg/ml) then I start eating first, before injecting Fiasp after approximately 10 minutes.

It appeared to be an enormous lifestyle change, after 35 years as a disciplined diabetic on mixed insulin, to switch to one daily injection with long-acting insulin and several meal-depending injections with short-acting insulin. Because of the new, short pen needles, the discomfort of the increased number of injections is low. It definitely provides for more freedom – for sure that there is no longer a need to eat at scheduled times is ‘liberating’. Also, the principle that I can actually eat what and how much I want (from a sugar/carbohydrates-perspective) is an advantage – if I want I can simply use my Fiasp-pen in case I choose to eat a piece of cake.

Previously, when people would ask about my eating habits (I used to bring a bag of bread to work – that is without any filling) I would reply that I simply eat to keep my blood sugar in check, but that dinner was the time to really enjoy. Nowadays I am also looking forward to lunch time! Nice!

In my ‘former’ life I have controlled my diabetes, mainly by feel and infrequent finger prick tests, beside the more regular HbA1c assessments, using the increase/decrease of food as a tool. As mentioned before, the new insulin therapy has resulted in a lifestyle change in a short time. This new lifestyle, however, kind of made me addicted to continuous monitoring of my blood sugar values. I honestly don’t know if I could have successfully made this switch without the FreeStyleLibre. I learned, for example, through constant monitoring, that now and then I injected too little Fiasp – a new pen would inject some air before insulin; that certain sports activities are affecting/draining my muscles the night and even the next day after the activity, and send my blood sugar levels toward 2-3 mmol/l; and there are more examples of how continuous monitoring allows you to intervene and control blood glucose.

In the Netherlands CGM (continuous glucose monitoring) devices are not reimbursed, so you either stick to finger pricks or to personally pay for the costs. Like I said before, I currently live in Germany and my ‘Kranken Kasse’ pays for the FreeStyleLibre sensors.

To conclude:

In my work, but secretly also privately, I am fascinated by managing changes. To make people realize that the change will have not a negative but a positive impact. Moreover, the next step-by-step process to actually implement the change.

But why, and this question keeps bugging me, is it that I have opened up so late to this change to my insulin therapy? Why did I not hear this before, or did not want to hear?

This question is also at the centre in one of my next blogs, about a sudden change to my lifestyle with respect to food and nutrition.


FURTHER READING

Toujeo

This is a long-acting insulin, glargine, from Sanofi, that is delivered to your body slowly and continuously over 24-30 hours resulting in a steady-state.

Fiasp

Fiasp, from Novo Nordisk, is also called a mealtime insulin, to be injected right before or up to 20 minutes after the start of a meal. Maximum activity is reached somewhere between 1 and 3 hours after injection and it wears off after 3-5 hours. Fiasp = Fast-acting insulin aspart (NovoRapid).

Candesartan: Angiotensin 2 antagonist inhibitor resulting in relaxation and dilatation of vessels; it also stimulates excretion of natrium (salt) via urine. Both effects help to lower blood pressure.

In my first blog I have touched on my personal memories of the time shortly before and after the diagnosis with diabetes and on the the changes it brought about. In this second blog I will tell you a bit more about my memories of some of the periods in which my lifestyle changed as a result of having the disease.

Conservative therapy with mixed insulin requires discipline

Definitely according to modern therapies, I was conservatively established on a therapy with mix insulin, Novomix 30. One injection before breakfast and the second before supper. Three main meals and three ‘snacks’ in between. I am not sure whether or not I was already a disciplined person before my diagnosis, but I have never skipped a single injection or meal in all those 35 years. This implied that often I would decline food when, for instance, people would offer treat to celebrate, and often enough I would start eating when nobody else did, just because it was time for my snack or because my blood sugar was dropping.

I realized only much later that other therapies may have advantages, for instance using long acting insulin and injecting short acting insulin before eating.

More about this in blogs to follow.

My lifestyle, the first 35 years, was quite old-fashioned, as a diabetic, that is. Focus was for me to prevent high blood glucose levels, no consumption of sweet food and limited carbohydrates. I considered a low glucose level of e.g. 3 mmol/l (<60 mg/ml) a much better outcome than a relative high value of e.g. 12 (>200 mg/ml). Also, a low level was an opportunity to eat candy, like a mars, or have a sandwich with syrup.

At home, my mom was, and is, the queen of homemade apple-pie – really delicious, especially when right out of the oven! Until not so long ago, a whole pie would be baked just for me, without sugar, but with candarel sweetener (the powder is mostly used for warm meals, whereas the liquid sweetener is better in cold dishes). Still, the rest of the siblings claims to be upset when looking at the homemade apple pies and the largest one being mine, upon celebrations where we tend to meet each other at the family home. I am sure they are just kidding… or aren’t they?

In the early days of my diabetes it was recommended to have your blood glucose levels >3 and < 10 (>54 and <180 mg/ml), but my current doctor (in Germany) classifies every value below 4 mmol/l (72 mg/ml) a hypo. I tried to find the (Dutch) ‘>3 and <10 campaign’ on the internet. Nothing there. Although not a very frequent self-monitor of my blood glucose, I did stick to the 3-4 monthly analyses of my HbA1c by the laboratory. The value was almost all the time around the 6% (people without diabetes have a value of 4-6%; diabetics should aim for values below 7%), telling me that the mean blood glucose levels were in range for the last 2 to 3 months. That was comforting news, although it is possible that the relatively solid values were the result of many/long-lasting low values (“Sie unterzuckern” is what my current doctor says). To check that I should have made more day curves and monitor glucose levels every 2 hours – see next blog for more.

Sports and jojo-effects

At the time of my diagnosis I played some tennis; in my first blog I mentioned to have taken on fitness, when I was losing so much weight.

When starting the insulin therapy, I remained playing tennis, increased fitness frequency and intensity – I increased weight at high speed, from 59 kg towards 90. I also decided to start playing basketball and field hockey, bringing my average of sports activities to 4-5 times per week. Not just for fun, but also helping me to burn energy/sugar to retain low blood glucose levels.

I have ended up in some bad situations because of it. As a young man I could deal and function pretty well still with blood glucose levels of around 3 mmol/l (54 mg/ml); in case the low levels remained for longer periods I kind of switched to auto-pilot, functioning in some kind of dream world. Now and then I have really given my body a beating with all the sports activities. Like the time I was stationed as a postdoc at the MD Anderson Cancer Center in Houston, Texas, playing basketball almost every night with the med-students at the campus courts. It happened a few times, getting to bed at home afterwards, that I woke up in the ambulance. Whatever sweets I ate or drank during and after the games, the muscles apparently wanted more and more sugar from the blood resulting in hypoglycaemia, which for me indicated that my blood glucose levels must have been under 2 mmol/l (36 mg/ml) for quite some time.

No fun! Especially not for my next of kin. When, after a glucagon injection, I would regain conscience, in an ambulance or not, I would be overwhelmed by a tremendous sense of guilt. I should have monitored my glucose levels more frequently, I should have eaten more, I should not scare my wife and children so badly, …

Having diabetes never stopped me from travelling, neither privately nor work-related. In case of transatlantic flights to the U.S. I would remain on the European time schedule with my two Novomix injections for as long as possible, and would take one extra injection before American supper. To calculate the extra units of insulin I did the following. The total number of insulin units of one day divided by 24 hours would give me the number of units per hour – with a time difference of 8 hours (the west coast is 8 hours behind) I would inject 8 times that number of units. On the return trip I would reduce the total amount of insulin with that number of units. Always seemed to work quite well.

 

With today’s knowledge …

With an active lifestyle, travel and/or sports it can be of benefit to have an insulin therapy that fits that lifestyle and is flexible. Although I have been able to live my life the way I wanted with a mixed insulin therapy, in hindsight I think it might have been easier if I had made a switch sooner, to a treatment with separate long-acting and short-acting insulins.

 


FURTHER READING

Novomix 30

Novomix 30 is a mix containing 30% fast-acting insulin aspart, and 70% long-acting insulin aspart protamine crystals. The insulin mix starts working within 10 to 20 minutes and the fast-acting insulin reaches a maximum effect between 1 to 4 hours after injection, whereas the long-acting lasts up to 24 hours (steady state).

Hypoglycaemia

The term hypoglycaemia is used when blood sugar level drops to below 3.8 mmol/l (70 mg/ml). The symptoms and the severity can vary per person. With the body trying to increase blood glucose you may experience shaking and sweating. When still capable, best remedy is to consume sugar (monosaccharides), like Dextro Energy. You can purchase glucose/dextro tablets that are easy to carry with you – also effective, but with a lesser fit in your pockets are the so-called high-energy sports drinks. When eating or drinking is no longer possible, glucagon can be injected. Glucagon is a hormone acting on the liver via the blood to release glucose.

 

HbA1c: HbA1c

Red blood cells transport oxygen in your blood using the haemoglobin (Hb); during their lifespan of approximately 3 months Hb will bind sugar: the higher the blood sugar the more will be bound and the higher the HbA1c value.

In this blog I will take you to the specific period of my life being diagnosed with diabetes at the age of 15. Today, after approximately 35 years, I still vividly remember certain details. Funny enough, one of the first things is that the tennis tournament at Roland Garros’ was ongoing and that I was watching the finals from the hospital bed: Mats Wilander, the Swede, beat Guillermo Vilas, the Argentinian predecessor of the Spanish Rafael Nadal. Vilas’ dedication – he trained 6 hours per day on average, and it was fascinating to observe that, being a lefty, his left arm was twice as thick as his right one.

I don’t know if this is a tell of how the lifestyle change has been communicated to me, but apparently, I have digested the diagnosis and proceeded with the important things in life – likely, tennis was one of these at my age of 15.

What were the indicators of diabetes?

Going back in time I can actually experience the taste of bitter lemon, the soda. Thirst and the urgency to go to the loo. At the same time. And a lot and often. Like most 15-year olds, I lived with my parent, together with brothers and sister. We had a lavatory that I frequented on the ground floor, next to the storage closet with bottles of soda. At night, and sometimes several times, I would jump out of bed, go down to get a bottle of bitter lemon. I would sit down on the loo and urinate, while drinking from the bottle. Hell was I thirsty!

Second signal: “what about some more exercise?” well-intended remarks from parents and brothers looking at my body that, despite a reasonably sporty life, looked kind of skinny. My elder brothers were already using some kind of fitness instruments, like hand and chest muscle exercisers, and I was given an arm-force-controller to strengthen my muscles.
Still, I kept losing weight which dropped to around 59 kg, which is not a lot for a 15-year-old with a height of 6’4. The so-called body-mass-index (BMI) of 15.7 (weight divided by (height times height) in kg/sq meter indeed suggested underweight.
A visit to the general practitioner was quickly made, and a blood test revealed an elevated level of glucose in my blood. An appointment was made with a befriended internist and from that moment on I was officially announced diabetic.
I was hospitalized for a week, receiving lots of information. Practicing injecting, using syringes on oranges, blood sampling for all kind of tests, and of course fingerpricks to measure blood glucose; these were the eighties and at that time still triangulated lancets were used, which were actually cutting your skin and hurt really badly. To the eye doctor, to the dietician, and to other doctors I do no longer see to remember. Every time I was told the same story, that the absence of insulin not only prevented the uptake of sugar by the cells of the body (and consequently the generation of energy for proper functioning of cells and the body), it would in the long run have all kind of nasty effects on the heart and vascular system. Nice to hear. Not! Especially not for my parents. As a 15-year-old I did not care much. An adolescent, having arrived at puberty, typically does not look ahead much further than a few hours. All the attention, initially, was not all too bad.

But then you also get a lot of attention that, as an adolescent, you really could do without. Everyone seems to know someone diabetes. My teacher French said that she had an uncle who lived with diabetes to become 90: “so you can grow old having this disease”. As if I had any concerns about old age at that time. Or horror stories about amputations, caused by poor blood vessels. Or my first visit to the Dutch Society Diabetes (DVN): I am sure well-intended advice has been given, but I remember coming home that I said that every was wearing glasses, with thick glasses like jam jars.
Me, I thought it was all very simple: same life as before, just stay away from sweets, count your carbs, and inject the missing protein (insulin). Other than that, keep doing like before, in and outside of school. To my environment I was undergoing an enormous lifestyle change. For me, I was not really aware and continued to be a happy adolescent having reached puberty.

Change-management plan

In my professional life I have been subject to and have organised several changes, for instance to improve processes, to replace certain internal positions by external ones, to start using new procedures, and so on. Beforehand, a detailed communication and implementation plan is made. The reason for the change and the implications for the organisation and the individual. The latter can be a hot topic for those affected by the change, and the supervisor can take away some of the tension by saying it is okay to be afraid of the upcoming change. That the change beside advantages can potentially have some negative aspects as well. Or provide examples of how other companies or persons have dealt with similar changes.

I doubt it, that at my diabetes diagnosis a detailed change management plan was in place.
I find it interesting now, in hindsight, to think about it; about the advantages and disadvantages of the disease, for instance. The major disadvantage, of course, that the body is no longer capable of producing insulin and that, in case your cells and organs want to keep on functioning, you need to daily self-inject the protein. With 35 years’ diabetes experience I also see the advantages that coincide with this lifestyle change: a focus on healthy living, having my blood glucose values as reminders: regular and proper food low in sugar and fat, regular exercise.

I will tell you more about this in my next blog.

 


 

FURTHER READING

Insulin
“you only know that you miss it when it’s gone” is an appropriate saying considering diabetes, missing insulin. In case your body does not produce insulin, your diabetes is called diabetes (mellitus) type 1; in case your cells have become insensitive to the insulin your body produces then your diabetes is called diabetes type 2.
Insulin is a hormone produced by the pancreas and secreted into the blood (by a group of cells belonging to the pancreas (islets of Langerhans)). Hormones are signal compounds/proteins that reach the target cells in the body via the bloodstream.
Your cells need to take up sugar as fuel. Without it no energy is produced, and cells will fail to grow or function. Normally insulin is being secreted in case of a rise in blood glucose levels – this because of mono-saccharides (glucose) that have entered the blood for example after drinking soda; a sandwich contains poly-saccharides (carbohydrates) that are being degraded into mono-saccharides first before entering the bloodstream and giving rise in blood glucose level. When the pancreas secretes insulin into the blood it stimulates the uptake of sugar (glucose) by the cells from the blood and inhibits the breakdown of fat and polysaccharides.
When you are not diabetic then your glucose levels are stable around 5 mmnl/l or 90 mg/ml. In case insulin is not around the glucose levels in the blood go up, the cells in your body will no longer take up glucose to produce energy, breakdown of fat and glycogen is no longer inhibited. You will get tired as a consequence; also, you will drink more and secrete more urine, because of the kidneys’ efforts to get rid of the surplus of glucose from the blood. Your body cries out for energy and start burning what is available, starting with fat, with muscle mass next. You will start losing weight.

Of all countries I have lived in the glucose levels are expressed in mmol/l in the Netherlands and Eastern-Germany; the unit mg/ml is used in the USA, Western-Germany and Austria. Glucose is a mono-saccharide consisting of 6 carbon atoms, 12 hydrogen and 6 oxygen atoms (C6H12O6). 1 mol glucose has a weight of 180 grams, with a mol being a huge number often used to indicate the quantity of a compound; in analogy to a dozen (being 12 pieces) a mol indicates 6,022 14 × 1023 particles/molecules. A millimole, mmol, is one thousandth of a mol (10−3 mol).
It may suffice to remember that 1 mmol/l glucose equals 18 mg/ml glucose; the norm value of 5 mmol/l therefore equals 90 mg/ml.