How John Reversed His Diabetes, and Reduced His Knee Pain

               Meet John. John is a client of ours, in his 50s. When he first started working with us, he was morbidly obese, headed towards full-blown type 2 diabetes, and had pain in his left knee. Nowadays, he’s lost significant weight, his blood sugar levels have nearly normalized, and the pain in his left knee – almost completely gone by now. In this article, I’ll explain what we did with him to have such dramatic changes.

               We’ll cover:

• How the knee pain, obesity and high blood sugar levels were affecting John.
• What he’s tried in the past to help him
• The exercise and nutrition strategies that we used with him, along with the thought process behind them to help him improve his obesity, blood sugar levels, and knee pain
• The results that he achieved
• Challenges that he experienced along the way
• How his life is different now, that his weight is lower, blood sugar is nearly normal, and knee pain is almost gone

If you’d like to see John tell his own story, you can check it out below (he didn’t turn his camera on for privacy/confidentiality reasons).

And if you’re jealous of John, and want to lose weight, improve your blood sugar, or decrease your knee pain, just email me with the issue that you’d like to get help with in the subject line.

How the Knee Pain, Obesity and High Blood Sugar Levels Were Affecting John

               First, let’s start with the obesity and the high blood sugar. The obesity issue was just a nagging issue at the back of his mind. It was one of those things where he knows intellectually he should, but the work that would need to be put in to change his nutritional habits was just not worth it… at first.

               The diabetes, John didn’t even know he had, until he got tested. When he went for his annual physical in 2018, his HbA1C was 5.5%. Because it was good, he didn’t get it tested in 2019, but he got it tested in December 2020. It was 10.0%. That’s high. Really high. A diagnosis of diabetes is made when HbA1C is 6.5%. 

Let’s backtrack though. What’s HbA1C? That’s called “glycated hemoglobin” (or haemoglobin for my British readers). Basically, it’s your average blood sugar over the last 3 months. Unlike fasting glucose, which is only your blood sugar at the moment that the blood is taken, this is a longer-term measurement.

               The diabetes diagnosis was a serious alarm that lit a fire under John’s tuchus, and got him on the path to losing weight, and improving his blood sugar.

               Nonetheless, when he started working with us, the obesity was not a big priority, and he didn’t even know he had diabetes yet. The big driver to start working with us was his left knee. It hurt. It acted funny, and it was unpredictable.

• Sometimes, the knee just wouldn’t support his weight.
• The knee would just buckle without any warning. When it buckled, the pain was terrible, to the point that he wouldn’t be able to walk for 1-2 days.
• John coaches basketball, and you can imagine that there’s a lot of side-to-side movement, so the knee pain didn’t allow him to coach as well as he could
• Cycling is something John enjoys doing. Cycling hurts when your knee is damaged, so he just didn’t cycle as much as he’d like.

To make things even more frustrating, X-rays didn’t really show anything wrong with the knee. It’s one thing when you know what’s wrong. You can tackle it. But it’s another thing when objective evidence shows no evidence of damage, but you live in your own body, and you know something’s not right. 

What He’s Tried in the Past to Help Him

               John has tried a number of things to help his knee before he started working with us:

• Walking. But that only made it worse.
• Exercise bike: also didn’t work well.
• Rehab exercises with the local hospital: despite doing these faithfully for a while, he didn’t see any improvement there either. Mostly because these were generic “knee pain” exercises. As I explain in my article on knee pain, personalization is key to improvement. To personalize, you have to assess.

John’s Initial Assessment

               After trying a bunch of things without them working, his wife suggested to John to work with someone from my team. She saw me speak at a personal training conference, and has been reading my articles for a number of years, so when her husband needed help, she knew who to call… ghostbusters. Oh wait. I meant me. My mistake.

               Because John lives in Nunavut, I set him up with one of my trainers, Shaneh, who’s got a great track record with virtual training. You might remember him from other success stories, like those of Neil, Andrea, Sravya, and others.

               Here’s what Shaneh learned about John during his initial assessment:

• Shaneh’s suspicion was that John’s knee pain was coming from a pelvic imbalance
• Shaneh tested the way that John’s thigh bone moved inside the hip socket, and he saw severe limitations in both internal rotation and external rotation
• When Shaneh asked John to stand on one leg, his hip protruded out, indicating hip instability.
• A big chunk of the muscles that Shaneh tested were tight: hip flexors, quadriceps, and others.

But let’s back up a second: John’s knee hurt. Why did Shaneh test John’s hips? Because as I’m fond of saying, very often the site of pain is not the source of pain. Because the hip is “north” of the knee, a lot of hip/pelvic issues will translate lower down, to the knee and ankle. Especially since a bunch of muscles cross both the knee and hip/pelvis (like the quadriceps, hamstrings, and others).

It makes sense why the X-rays didn’t show anything. First of all, the X-ray was looking at the knee (the site of pain)… not necessarily the hip (the source of pain). X-rays are great for what they’re meant to do: detect bone and joint problems. But if the problem is muscular, X-rays won’t pick that up. That’s where movement testing is necessary.

Now that Shaneh has been able to identify the source of John’s knee pain, they could work on a much more personalized program to decrease John’s knee pain.

The Exercise Strategies We Used with John for His Knee Pain

               When Shaneh and John were just starting to work together, before fat loss and diabetes reversal was a real priority, the first 3 months, the workouts were very rehab-oriented.

               Some of the exercises that Shaneh had John do were:

• Bird dogs and dead bugs: these were used to improve core stability. As I outlined in my article on predicting injuries before they happen, there’s a relationship between core stability (which is not the same as core strength) and lower body injuries. The purpose of these exercises is to keep the pelvis stable even when the lower body is moving.
• Lots more core stability work: hip raises, planks, side planks, woodchoppers, and others.
• Additional exercises for hip stability, like clam shells
• Exercises to build leg strength, like step ups, hamstring curls, deadlifts and others. We know from my article on predicting injuries before they happen that a large strength discrepancy between the front of the thigh muscles (quads) and back of the thigh muscles (hamstrings) is a significant risk for knee injury. So Shaneh spent extra time strengthening John’s hamstrings.
• In addition to that, there was a strategic “dose” of stretches for tight muscles, like for the pecs (chest), adductors (inner thighs), hip flexors, piriformis (side butt), quads and hamstrings. As I outline in my many articles on stretching, there’s a proper way to stretch, and an improper way to stretch. Based on Shaneh’s assessment of John, he determined that stretching would be beneficial.

These are the exercises used, but the real “secret sauce” behind any exercise program is not even the exercises themselves. It’s the progression model. If in 3 months, you’re doing the exact same sets, repetitions and weights that you were 3 months earlier, you won’t move very far. You have to adjust the workout ever so slightly every 1-3 workouts to accommodate to the client’s adaptation of that program. I talk about this in much greater detail in my article on the most important factor in an exercise program.

The Exercise and Nutrition Strategies We Used with John for Fat Loss

               As I mentioned earlier, although John realized that he was morbidly obese (his words, not mine), and knew that he needed to lose weight, it wasn’t urgent enough to do anything about… until a couple weeks before the diabetes diagnosis came. That was after about 3 months of working with Shaneh on his knee.

               Fortunately, after 3 months of work on the knee, it was almost back to normal, and they could now switch focus to reversing the diabetes. Part of that would be fat loss (plus fat loss would be beneficial for the knee as well).

               So Shaneh built the program around large, multi-joint exercises, like kettlebell swings, rows, squats, chest presses, pushup variations, and other exercises that I talk about in my article on compound exercises for weight loss.

               In general, he used the approach that I wrote about in my article on exercise for weight loss.

               As for the nutrition side of things, once the diabetes diagnosis hit, he knew that he can’t ignore his nutrition anymore. He had to take things seriously now. So Shaneh recommended the obvious things: eat more veggies, reduce starches and desserts, and ate more fibre in the form of beans and lentils. Nothing all that fancy of out of the ordinary there.

               The thing is we know what we need to do to lose fat. Then why don’t we do it? Our old, ingrained habits. That’s why. As I often say, “information isn’t motivation.” Just because you know what to do, doesn’t mean it will lead to long-term behavior change. That requires addressing things like:

• Emotional eating
• Stress eating
• Snacking
• Planning

Those things don’t get addressed with fine knowledge of nutritional biochemistry. So John downloaded the Noom app, to help him with the changes necessary to modify his behavior long-term. Combined with the regular sessions that he has with Shaneh, that has helped him lose weight.

Part of long-term behavior change is accountability and tracking. You have to know if what you’re doing is working. So although it’s not a nutritional strategy per se, one thing that John was doing is measuring his blood sugar 3-4 times per day.

John’s Results

               John’s results are nothing short of life-changing. I don’t use the words “life-changing” very often, but in this case, that’s an accurate description of what happened.

               Check this out:

• He lost 17 lbs so far.
• His HbA1C (blood sugar) dropped from 10.0 to 5.7. This is essentially a reversal of his diabetes.
• His fasting blood glucose dropped from 17.1 mmol/l down to consistently under 6 nowadays.
• His cholesterol and triglycerides have also improved. 
• His waist circumference decreased by 7 cm.
• His hip circumference is down 3 cm.
• His chest circumference is down 5 cm.
• His internal rotation at the hip improved by 5 degrees in both the right and the left sides
• His external rotation at the hip improved by 2 degrees on the left, and 5 degrees on the right
• His adductor (inner thigh) range of motion improved by 10 degrees

Challenges He Experienced Along the Way

               Rarely does everything go as planned. There’s this thing called “real life.” And real life entails time limitations, family obligations, work obligations, and more. That’s normal.

               So John had his share of challenges along the way.

• When he first started, he wanted to do the bare minimum necessary to improve his knee pain. The bare minimum was pretty much limited to his 1-2 sessions per week with Shaneh. He did see some progress, but it was real slow going. So he realized that he needed to do more. At first, Shaneh had introduced a daily 10-minute stretching routine for John to do. Sure enough, he saw faster progress, and was motivated to do even more. So Shaneh introduced workouts 3 times per week, and John saw further improvements in his knee.
• The big challenge: covid lockdowns. Because of this, John ended up purchasing an indoor bike. 
• The other big challenge: his diabetes diagnosis. Fortunately, because he was already exercising, he was able to take the diagnosis in stride, and make adjustments to his nutrition to bring it under control.

Despite these challenges, John has made some excellent progress, and we’re very proud of him.

How His Life is Different Now

               So now that his knee is better, he’s 17 pounds lighter, and his diabetes is under control, how is John’s life different? This is where I said that his transformation is literally life-changing.

• Type 2 diabetics live an average of 2 years less than non-diabetics, according to the endocrinology network. By normalizing his blood sugar, he added years to his life. And life to his years. Because not only do diabetics live less, the quality of life during the last few years is worse than the quality of life of non-diabetics.
• He’s 17 pounds lighter, and has a smaller waist circumference. Time for a new wardrobe, or to tighten up the belt another couple of notches.
• His knees would be very sore after cycling before. Now they’re not.
• When he coaches basketball, he can now move side to side. That wasn’t an option before without excruciating knee pain.
• Nowadays, when his knee is sore, it’s just a minor twinge or soreness. He’s not in bed for 1-2 days.

All in all, John continues to do better and better, and we can’t wait to see what the next 6 months hold for him. If you’re jealous of John, and want to lose weight, improve your blood sugar, or decrease your knee pain, just respond back to this email with the issue that you’d like to get help with in the subject line.