Dan,
Yes, I definitely remember our conversations earlier this year. In fact, it was some of your comments that got me to look more into thiamine, and I’ve read a lot of goodies since then!
But I’m definitely sorry to hear that things are not better for you!
Here are some thoughts. Stasis dermatitis is common in diabetics (well, relatively common), and the tingling sensation you describe in your legs is a documented feature of the poor venous flow. However, I’m not sure how or why fat would be related to this, outside of the possibility that the dietary fat is increasing the absorbed endotoxins from the GI tract (which it does, but usually isn’t a problem), and that this is exacerbating your inflammatory reaction in your legs.
Do you ever eat egg yolks? Or liver? Phospholipids (which make up a considerable portion of the fat in organ meats and yolks) are absorbed a bit different than dietary triglycerides (most dietary fats). Besides the fact the deficiencies in choline can be a big problem (choline is associated with phospholipids in liver and yolks), it might be diagnostic to see if you had lessened or worsened reactions from eating egg yolks instead of other fat for a meal or two. But to be honest, I really don’t have any knowledge on venous problems.
In terms of the lipid and A1C issues, I have some thoughts. First, for the A1C issues. A1C is just a marker of the amount of glycation on heme. So, the number will go up with high glucose levels, but it will also go up with many forms of anemia. It is important to note that in iron deficiency anemia (or in copper deficiency anemia, or potentially even molybdenum deficiency), the heme in blood cells is degraded more slowly (because our body doesn’t have enough iron to replace it), and this allows the heme to collect glycation sugars to a greater extent. Thus, without knowing fasting glucose and/or insulin, or having a 2-hour OGTT (oral glucose tolerance test), it would be difficult to interpret the A1C. I know most doctors are more than willing to claim a high A1C as indicative of diabetes without further testing, but that’s not accurate. And I’m not saying to go get more tests done, I’m just saying more would be needed for proper interpretation (and perhaps you already have these done).
http://www.ncbi.nlm.nih.gov/pubmed/15345893
For lipids, fructose certainly can increase triglycerides, because fasting triglycerides are a marker of how much fat the liver is synthesizing de novo. The more dietary fructose and the less dietary fat, the more de novo fat synthesized. This is not a problem in and of itself, but it certainly does increase choline requirements and it may indicate overall fat deficiency (your liver is making more fat because the body needs it). This is obliviously not easy to solve if fat worsens your symptoms. But the good news is that fructose can provide the substrates for your liver to make fat (whereas glucose doesn’t as much), so if you must consume lower fat, then having higher sugar is better than higher starch, in my opinion. Now, copper is interesting here, since copper deficiency causes an increase in the amount of fat synthesized in the liver, both triglycerides and cholesterol. I don’t know if the amount of extra lipid material is excessive in copper deficiency, or if copper deficiency somehow increase the peripheral need for fat which is why the liver is making it. But either way, increased LDL-c and/or triglycerides, especially when an anemia is present and/or neurological problems exist, may be very indicative of a long-standing copper deficiency.
Thanks for the collagen and fructose links. Fructose does increase, at least in a test tube, glycation to a greater extent than glucose. But alpha lipoic acid has been studied to increase glutathione and decrease oxidative stress, and copper deficiency causes increased oxidative stress. So, again, I think a good chunk of this is just the same ole? fructose causes copper deficiency, which interestingly may be much worse in men than women. Notice how the one study you showed me shows how men are more affected by fructose in terms of collagen crosslinking. Well, check out the last 2 links here that shows males worse off with copper deficiency than females (rats, that is).
http://europepmc.org/abstract/MED/1418040
http://www.ncbi.nlm.nih.gov/pubmed/12049840
http://www.ncbi.nlm.nih.gov/pubmed/1325594
http://www.ncbi.nlm.nih.gov/pubmed/12805251
What concerns me the most about your symptoms are the neurological ones. Eye sight, for instance, is temperamental and not easily restored if something goes wrong. Sure, diabetes could cause problems relating to eye sight, but so can deficiencies in choline, copper, B12, protein, zinc, A, D, B2, the essential fatty acids (ARA and DHA; both in liver and pastured egg yolks; ARA in conventional yolks, and DHA in fish). There may be a variety of other things that could cause vision problems too, and electrolyte imbalances can create temporary issues. But if you’ve been avoiding fat for some time, than it could be that you are deficient in vitamins A, D, K2, E; ARA, DHA; and choline/phospholipids. Eating at least few yolks per day, plus the extra vitamin A and D would be something good to do right now, I would think, even as you works everything else out. Perhaps experimenting with copper and/or some other things little by little may help you tease out what is going on. That ‘balanced’ zinc/copper supp you mentioned, what is the ratio on that? I think most are too far in favor of zinc. But something like 10-15mg zinc and 3-5mg copper should be ok as a supplement, I would think. I know ratios of 10:1 to 15:1 Zn:Cu are recommended, but I think lower ratios are ideal (perhaps 5:1), especially when phytic acid foods (grains, legumes, seeds, nuts) are not consumed, since phytates inhibit zinc absorption while doing little or nothing to copper.
Also, I would ignore any bashing you read or hear on copper on the internet. It’s misplaced. Copper levels in the blood increase in times of acute or chronic illness, much like zinc and iron decrease. These are all called ?acute phase reactants?, because their levels change in acute (or chronic) inflammatory conditions. C-Reactive Protein is another acute phase reactant, and since it elevates in many instances of illness, it is used as a marker for disease severity. Serum copper could be used the same way, as a marker of illness severity, but that does not mean one with elevated serum copper is ?overloaded? with copper any more than someone with elevated C-reactive protein is overloaded with the letter ?C? because of eating too much alphabet soup. Severe copper deficiency will lower blood neutrophils (neutropenia) and could cause anemias of all types (with low, mid, or high MCV and MCH). There are many ?clues? of copper deficiency in a blood test, but serum copper itself, is not usually one of them. I think supplementing 3-6mg copper per day (in divided doses) and judging your health response is likely the best way to determine copper status, but you can stop at any time if you don’t think it is going well. Copper could theoretically increases the requirement of molybdenum, so supplementing some molybdenum with copper may not be a bad idea (I would suggest something like a 10:1 ratio Cu:Mo; or 3mg Cu with 250 mcg Mo). But go by feel.
In terms of diabetes and glucose control, deficiencies in potassium, thiamine, and magnesium would all causes an inability to process glucose through glycolysis; and diseases with wasting of potassium and magnesium (such as hyperaldosteronism) always causes a worsening of glucose control, while hypoaldosteronism can actually causes life-threatening insulin sensitivity and low glucose. But if you’re eating lots of fruits I don’t think potassium or magnesium would be a problem. It’s the refined sugars and starches that could be problematic from a potassium/magnesium standpoint (and a copper point of view), since they are void of these nutrients, but require them for proper processing. So, again, this is where fruits and tubers should be fine as staples, while refined sugars better in moderation or not at all. In cases where, let ‘s say cane sugar for example, are tolerated better than fruit, I would recommend supplementing alkaline salts of potassium and magnesium (citrate, for example) along with the sugars, and consider supplementing thiamine somewhere in there, too. But this is just me saying don’t induce a further deficiency in something while you are playing around with finding what is already wrong.
All-in-all, it sounds to me like your body is beaten down quite a lot and that you have a long road to recovery ahead of you, even if all goes well from here on out. I wish I could wave a magic wand and cure you. I suspect you have many long-standing deficiencies, and that fixing one may produce some negative effects along with the positive, since fixing one rate-limiting reaction may causes another to be rate limiting to the point of a new set of symptoms. So, if something feels good at first, but then begins to produce undesirable effects, I wouldn’t take it as that thing being bad but that something else is now needed with it. For instance, many supposedly feel weird taking iodine, but then notice that extra chloride, selenium, B2 and B3 seem to make everything swell. And anecdotally, magnesium, potassium, and niacinamide help those with sudden increases in methyl donors.
Those are my thoughts. Let me know your own thoughts, and keep in touch either way.
Cheers, CP